Core Competencies WHO African Region · shifting or sharing, this policy document is a unique...

Core Competencies

for the Eye Health

Workforce in the WHO

African Region

WHO African Region | I

CORE COMPETENCIES FOR THE

Eye Health WorkforceIN THE

WHO African Region

II | Core Competencies for the Eye Health Workforce in the WHO African Region

Core competencies for the eye health workforce in the WHO African Region

ISBN: 978-929023418-0

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WHO African Region | i

ContentsContents ................................................................................................................................................ i

Acknowledgements .......................................................................................................................... ii

Foreword ............................................................................................................................................. iv

Abbreviations and acronyms .......................................................................................................... v

Working definitions .......................................................................................................................... vi

Chapter 1: Introduction .............................................................................................................................................1

Chapter 2: Classification of the Eye Health Workforce .............................................................................................5

Chapter 3: Roles of the Eye Health Workforce .........................................................................................................9

Chapter 4: Competencies for Ophthalmologists ....................................................................................................13

Chapter 5: Competencies for Optometrists ...........................................................................................................19

Chapter 6: Core Competencies for Allied Ophthalmic Personnel ..........................................................................27

Chapter 7:Common Non-Clinical Core Competencies for the Eye Health Workforce .........................................35

Chapter 8:Implementation .....................................................................................................................................41

References .........................................................................................................................................43

Annexes ..............................................................................................................................................44

ii | Core Competencies for the Eye Health Workforce in the WHO African Region

AcknowledgementsThe Core Competencies for the Eye Health Workforce in the African Region have been developed in

collaboration with a network of national, regional and international experts who provided guidance

throughout the development process participating in the review of drafts at every stage of its

preparation and development. The participation included the two rounds of the modified Delphi for

consensus on the competencies (the list of individual contributors is in Annex VII) which involved

a wider participation in addition to the face building or attending the two expert meetings held in

Nairobi (September 2017 and February 2018).

WHO secretariat therefore would like give special thanks to the following experts: James Amoo Addy

(Head of Eye Unit, National Coordinator, Prevention of Blindness, MoH Ghana); Mouctar D Badiane

(Coordinator of the national Eye Health Promotion Program, Senegal); Komi Matiklu Balo (Professor of

Ophthalmology, University of Lomé); Grace Chipalo-Mutati (Senior Medical Superintendent, University

Teaching Eye Hospital Zambia); Ellen A. Clegg (Former Principal, Ophthalmic Nursing School, Korle

Bu); André Omgbwa Eballe (Deputy Coordinator, Prevention of Blindness Programme, Cameroon);

Richard Ganga-Limando (WHO Collaborating Centre for Postgraduate Nursing & Midwifery Distance

Education, University of South Africa); Dunera Ilako (Consultant Ophthalmologist, University of Nairobi);

Godfrey Kaggwa (SiB Project Coordinator, Brien Holden Vision Institute, Uganda); Jefitha Karimurio

(Chair, Department of Ophthalmology, University of Nairobi); Abigail Kazembe (Associate Professor

& Deputy Dean, Kamuzu College of Nursing, Malawi University); Annette Kobusingye (Program

Manager, the Fred Hollows Foundation, African Region, Uganda); Aaron T. Magava (Chair, IAPB Africa,

Zimbabwe); Fikile Ntombi Mtshali (WHO Collaborating Centre - School of Nursing & Public Health,

University of Kwazulu-Natal, South Africa); Peter Mwangi Kirigwi (Optometry Technologist Trainer,

Kenya Medical Training College); Kolawole Ogundimu (Senior Global Technical Lead, Eye Health,

Sightsavers, Nigeria); Mollent Okech (Senior Technical Advisor for HRH, Management Sciences for

Health, Kenya); Joseph Enyegue Oye (Country Director, Sightsavers, Cameroon); Senanu K Quacoe-

Wossinu (Francophone & Lusophone West Africa, Co-Chair, IAPB-Africa); Zahra Rashid (Optometrist,

Kenya); Bernadetha Robert Shilio (National Eye Care Program Manager, Ministry of Health, Tanzania);

Kassa Tsehaynesh Tiruneh (acting National Eye Health Coordinator FMoH, Ethiopia); Linda Visser

(Academy Head, Dep. of Ophthalmology,Vice-President OSSA, President, College of Ophthalmology,

South Africa).

WHO would like to acknowledge the IAPB HReH task development teams who did preliminary

groundwork.

This Regional policy document has been drafted by the consultant services of Dr Michael Gichangi

(Head of Ophthalmic Services Unit – MoH Kenya) at the various stages. Simona Minchiotti, Renee

du Toit and Mwansa Nkowane contributed to the technical content of the document and provided

technical feedback to the consultant.

The steering group for the overall process was led by WHO and the International Agency for the

Prevention of Blindness for Africa (IAPB) with Adam Ahmat, Simona Minchiotti, Jennifer Nyoni and

Mwansa Nkowane (World Health Organization), in collaboration with Simon Day, Renee du Toit and

Ronnie Graham (The International Agency for the Prevention of Blindness – IAPB) and Luigi Bilotto

(Brien Holden Vision Institute).

WHO African Region | iii

The contribution of Dr Adrian Hopkins (Facilitator, Adrian Hopkins Consulting) who facilitated at both

experts’ consultation and the validation meeting as well as providing the technical proof reading is

acknowledged.

Within WHO we wish to thank Hillary Kipruto and Silvio Paolo Mariotti for their contributions.

WHO also wishes to express sincere gratitude to the Organisation pour la Prévention de la Cécité

(OPC, Paris, France) for translating the working draft version of the core competencies document into

French to facilitate the validation process of the experts.

Graphic design and layout was done by Rail Graphic Design CC (Durban, South Africa).

WHO acknowledges the financial contribution of IAPB and Sightsavers to the overall process of

developing this document.

iv | Core Competencies for the Eye Health Workforce in the WHO African Region

Foreword The majority of countries in sub-Saharan Africa are facing a severe crisis of skilled health workforce shortages that could impede the realization of Universal Health Coverage, especially in specialized fields such as eye health. This policy document is a step towards improvement of the quality of eye health care. It describes the development of core competencies for the cadres that constitute the professional eye health team.

In sub-Saharan Africa, an estimated 3.6 million persons are blind, 17.4 million have moderate and severe visual impairment, and 100 million have near vision impairment. Visual impairment does not only impact negatively a person’s quality of life but also the national and regional economy. The majority of people who are visually impaired are over 50 years old and many live in rural areas. This places a huge burden on the WHO African Region that already has a myriad of challenges compounding this shortage of skilled eye health providers. What is worse, the distribution of available eye health providers is skewed, with most of them deployed in the urban areas.

Given the shortage of human resources for eye health, and in line with the WHO approach to task shifting or sharing, this policy document is a unique contribution to detailing the competencies required of a range of eye health professionals. Countries can select and tailor these core competencies to meet their specific country needs. The corps of eye health professionals may share some competencies, but others are unique to some cadres. The selected competencies can then be included in educational curricula, enhancing a transformation of task shifting or sharing from often informal delegation and unstructured training to the production of competent eye health professionals who perform tasks that are within their role and allowed under country and professional regulatory frameworks. Team-based education is also in line with the WHO approach to inter-professional education and collaborative practice.

WHO continues to call for high-quality eye health services that focus on integrated, people-centred services. Integrated services ensure that there is a continuum of care that includes both promotive, preventive, palliative and rehabilitative eye care, and diagnosis and management of eye disorders – all coordinated among the different disciplines and providers. Person-centred eye care, for its part, means that the person’s needs and preferences are taken into consideration and that the person is an active participant in the provision of care. To this end, WHO urges that traditional teaching and learning methods be transformed into competency-based education. It also calls for traditional methods of education to shift towards an interdependence that harmonizes education with health systems and supports networking and collaborative practice.

WHO and the International Agency for the Prevention of Blindness (IAPB) are working towards the harmonization of tasks and roles in human resources for health (HRH) within a global framework, and have worked closely together to develop the tasks and roles of the eye health team of professionals in line with global standards. A rigorous process of engaging eye health experts and training institutions in the WHO African Region followed, with the aim of developing core competencies for the team, reaching consensus on them, and ensuring their ownership. The result of all these efforts was the validation of the present core competencies for the eye health professional team for the African Region.

This policy document is a first step in the development of competency-based education for eye health professionals that meets the needs of the African Region and its unique challenges. It is largely a reference document that can be used when reviewing or developing curricula for eye health professionals. Further, it can also be used in workforce planning, management, regulation, etc.

We envisage that use of the document will contribute to a higher quality of care that is harmonized across the Region. Its use will also spur development of the capacities of training institutions, strengthen health systems, and support eye health professional teams to apply the competencies acquired to the provision of quality eye health care as a step towards Universal Health Coverage.

DR MATSHIDISO MOETIWHO Regional Director for Africa

WHO African Region | v

Abbreviations and acronyms AFCO African Council of Optometry

AOP Allied Ophthalmic Personnel

AFRO WHO Regional Office for Africa

IAPB-Africa International Agency for the Prevention of Blindness - Africa Region

HReH Human Resources for eye Health

ICO International Council of Ophthalmology

ISCO International Standard Classification of Occupations

OCO Ophthalmic Clinical Officers

SDGs Sustainable Development Goals

SSA Sub-Sahara Africa

SAG Standing Advisory Group

UHC Universal Health Coverage

WCO World Council of Optometry

WHO World Health Organization

vi | Core Competencies for the Eye Health Workforce in the WHO African Region

Working definitions

Behaviour A way of conducting oneself in a specific environment.

CompetencySufficient knowledge and psychomotor, communication and decision-making skills and attitudes to enable the performance of actions and specific tasks to a defined level of proficiency.

Competency statement Description of outcomes expected from the performance of professionally-related functions.

Competent Ability to perform specific tasks to a defined level of proficiency using acquired knowledge, skills, and professional behaviour.

Core competency Aspects of a discipline that are common to all students, and that should be mastered in order to graduate and enable professional practice.

Competency domain Umbrella term covering areas of learning.

Competency-based approach

A disciplined approach that specifies the health problems to be addressed; identifies the requisite competencies required of graduates for health system performance; tailors the curriculum to achieve competencies; and assesses achievements and shortfalls. It embraces a highly individualized learning process rather than the traditional one-size-fits-all curriculum.

Eye health team In the context of this document, the focus is on the three skilled eye health professional groups (ophthalmologists, optometrists and allied ophthalmic personnel). The eye health team is generally larger than this.

Health behaviour Any activity undertaken by an individual, regardless of actual or perceived health status, for the purpose of promoting, protecting or maintaining health, whether or not such behaviour is objectively effective towards that end.

Health promotion The process of enabling people to increase control over, and to improve their health.

Health-seeking behavior Personal actions to promote optimal wellness, recovery, and rehabilitation (NOC 1603).

Integrated health services

The management and delivery of health services such that people receive a continuum of health promotion, disease prevention, diagnosis, treatment, disease management, rehabilitation and palliative care services through the different levels, specialities and sites of care within the health system, and according to their needs throughout the life course.

Knowledge Understanding of a subject and ability to apply skills.

People-centredAn approach to care that is consciously organized around and responds to the health needs, expectations, and preferences of the people or beneficiaries in a holistic manner.

Skill Ability to perform specific tasks to a specified level of measurable performance.

Universal Health Coverage

Ensuring that all people have access to needed promotive, preventive, curative and rehabilitative health services, of sufficient quality to be effective, while also ensuring that the use of these services does not expose the user to financial hardship.

Validation Ascertain and confirm through a process that the competencies are suitable.

Vision rehabilitation

A continuum of activities from assessment of visual functions through to provision of appropriate assistive devices and technologies, and social inclusion, all geared to optimizing visual functioning and a sense of well-being. (https://www.aoa.org/optometrists/membership/aoa-sections/vision-rehabilitation-section/membership-benefits/definition-of-vision-rehabilitation

Vision therapy

Also known as vision training, is defined as using a series of procedures carried out in home, school and office settings, sometimes with optical or non-optical devices, to improve residual vision and vision skills such as eye movement control and coordination. It is usually under professional supervision.

https://www.aoa.org/optometrists/membership/aoa-sections/vision-rehabilitation-section/membership-benefits/definition-of-vision-rehabilitation

https://www.aoa.org/optometrists/membership/aoa-sections/vision-rehabilitation-section/membership-benefits/definition-of-vision-rehabilitation

CHAPTER 5

Competencies for Optometrists

CHAPTER 1

Introduction

2 | Core Competencies for the Eye Health Workforce in the WHO African Region

1.1 Introduction

Worldwide, 285 million persons are visually impaired. Among these, 39 million are blind and 246 million suffer from low vision. Visual impairment increases with age (13). Sixty-five percent (65%) of the visually impaired and 82% of the blind are above 50 years of age (11). In Africa, there are 4.8 million blind persons and 16.6 million visually impaired; yet, even with the huge burden of eye disorders in Africa, less than 1% of the global number of ophthalmologists practise in Africa. Only 13 countries in Africa meet the minimum requirement of one eye health professional to 55,000 people (14). Most ophthalmologists and optometrists practise in urban areas while allied ophthalmic personnel (AOP) tend to move out of the capital cities to smaller towns.

While the rate of growth among the cohort of people aged over 60 years is 2.9% worldwide, the rate of growth of ophthalmologists is 1.2% (less than half) (15, 16). The shortage of human resources for eye health (HReH) has further been compounded by the limited capacity of the eye health training institutions in the African Region (Table 1). The eye health workforce crisis thus has an even greater impact in the African Region. To make a significant impact on the cataract surgical rate and coverage and correct refractive error, thus reducing vision impairment and blindness globally, sufficient skilled human resources for eye health are required (17, 18). The quality, quantity and distribution of health workers correlates with positive health outcomes (8). Health worker density is used as one of the indicators of service capacity and access used to monitor progress towards Universal Health Coverage (UHC) (2).

Table 1: Needs analysis and capacity of eye health training institutions in the WHO African Region

Category

Needs assessmentCapacity of eye health training institutions in the WHO African Region

Recommended ratios

Number required

Total existing

Existing gap Total number of institutions

Annual intake

Number of years to reach targets**

Ophthalmologists 1/250,000 4,000 2,075 1,925 (48%) 51 250 8

Optometrists1 1/250,000 4,000 8,900 90%* 27 500 7

Allied ophthalmic professionals

1/100,000 10,000 6,390 3,610(36%) 30 763

6AOP (clinicians) 24 277

AOP (nurses) 6 486

Source: IAPB Vision Atlas and Training Institutions Database* Estimates; ** figures not adjusted for attrition

1.2 The global call to action

The Lancet commission on education of health professionals for the 21st century, among many other recommendations, proposes the

Adoption of competency-based curricula that are responsive to rapidly changing needs rather than being dominated by static coursework. Competencies should be adapted to local contexts and be determined by national stakeholders, while harnessing global knowledge and experiences. Simultaneously, the present gaps should be filled in the range of competencies that are required to deal with 21st century challenges common to all countries… (1).

Efforts have also been made to emphasize patient- and population-centredness; inter-professional team-based education; IT-empowered learning; policy, management and leadership skills as the foundations for the future. This transformative change in teaching and learning methods in order to develop person-centred competent service providers is hereby proposed (20). In response to the needs of the WHO African Region, in 2011 the WHO Regional Office for Africa developed a roadmap

*±10,000 optometrists are in Nigeria and South Africa, and few other countries with a few hundred, 78% countries have less than 50, while some have 0 like Namibia. Jennifer J Palmer FC, Alice Gilbert, Devan Pillay, Samantha Fox, Jyoti Jaggernath, Kovin Naidoo, Ronnie Graham, Daksha Patel and Karl Blanchet.* Trends and implications for achieving Vision 2020: human resources for eye health targets in 16 countries of sub-Saharan Africa by the year 2020. Human Resources for Health. 2014.

WHO African Region | 3

(2012–2025) for scaling up the health workforce for improved access to services (9). The proposed roadmap addresses all categories of the health workforce and analyses the challenges facing the Region. Recognizing the importance of eye health, WHO issued a global call for achieving high quality care that focuses on two particular dimensions: people-centeredness and integration (19). The WHO global action plan for 2014–2019 (Towards Universal Eye Health) aims to reduce by 25% by 2019 the burden of visual impairment from the 2010 baseline. It recommends strengthening eye care services through integration into the health system, rather than following the vertical programmes approach. The starting point for scaling up the quality, quantity and relevance of the eye health workforce is to strengthen training institutions to produce more of the skilled professionals based on appropriate standards, and ensure their integration into the health system. The development of eye health competencies is a step in that direction.

1.3 The development process

Development of the core competencies for the eye health workforce will be the first course of training in the competency-based approach (1). Competency-based training is a more responsive and transformative method of education centred more on patient needs rather than the traditional way of training. IAPB and WHO engaged in a collaborative and extensive consultative process to develop the core competencies for the eye health team (Annex I). Eye health experts, trainers, policy makers and service providers have been actively involved in the process since 2013. A sequence of activities took place between that date and 2018. These are described below.

(a) Desk review: A broad range of reference documents were used including, the International standard classifications of occupations (ISCO-08) (for identified occupational roles) and CanMEDS (an existing competency framework for medical education).

(b) Expert consultations: Experts from English-, French- and Portuguese-speaking countries in sub-Saharan Africa were engaged with the aim of building consensus and validating the competencies. Two nominal meetings (Annexes II and III), and several e-meetings and consultations took place.

(c) Delphi survey: Two rounds of Delphi surveys were conducted and findings therefrom used to improve draft versions of the document.

(d) Validation: A validation workshop was held in Nairobi, Kenya, from 27 February to 01 March 2018 involving a wider group of experts and representatives of African Member States. The purpose of the workshop was to analyse in detail, evaluate, and review both the whole process and the document in order to definitively validate core competencies for the eye health workforce in the WHO African Region.

The primary beneficiaries of these competencies are:

• Ophthalmologists • Optometrists• Allied ophthalmic personnel (AOP).

These core competencies can be used as a starting point in developing competency-based specific training curricula for different cadres of the eye health team in the Region. This could help in harmonizing eye health programmes, thus improving the standard of care in the Region. In addition, the competencies will have several other uses. They can be used as a guide for self-directed learning, as an advocacy tool, and for assessments. There will also be a broad range of users of the competencies. They include:

(a) Educational institutions(b) Learners of eye health(c) Professional associations(d) Licensing and regulatory bodies(e) Policy makers, e.g., ministries for health and education.

Annex IV provides detailed options for their use.


1.4 The competence framework

The ultimate purpose of these competencies is to improve the quality and relevance of the care provided by the professional eye care health workforce. The allocation of specific competencies to a specific cadre of eye health personnel is the remit of training institutions and regulatory bodies. The document outlines a comprehensive set of core (minimum) competencies for the eye health workforce as a step towards development of competency-based training. The framework is divided into 10 domains comprising 4 clinical and 6 non-clinical domains. Each competence is further broken down into associated relevant knowledge, skills, attitudes and behaviours.

CHAPTER 2

Classification of the Eye Health Workforce


2.1 Introduction

The Ouagadougou Declaration on primary health care and health systems influenced the choice of CanMEDS – an existing competency framework for medical education and practice – as the appropriate organizing framework. It was adapted and 10 domains created to organize the competencies. The competencies associated with the domains, which are either unique or shared between the three professional workforce groups, are outlined in Section 3.

The International standard classification of occupations (ISCO-08) is a detailed four-level hierarchically structured classification system for occupations. It allows production of relatively detailed and internationally comparable data. Globally, it is endorsed by labour organizations and is used by WHO and the governments of many countries in Africa. ISCO-08 classifies, codes, and broadly outlines the services that health care personnel provide, along with their levels of autonomy and supervision (21).

2.2 Classification system

Whilst the categorization and definition of ophthalmologists and optometrists is, to a large extent, uncomplicated and uncontroversial, it is not so with the mid-level eye care workforce, as there is a wide range of nomenclatures, education and roles associated with these persons. Allied ophthalmic personnel (an alternative used in the literature to avoid the term ‘mid-level personnel’), are a heterogeneous group of staff with specialist ophthalmic training. In contrast to ophthalmologists and optometrists, AOPs often serve in rural areas (17). They work in interdisciplinary teams to receive patients with eye disorders. The patients are sent to them directly or referred from primary and community health workers.

AOPs diagnose and treat eye illnesses and refer patients with conditions beyond their scope of practice, thereby providing a bridge between ophthalmologists and primary and community-level workers. They also provide links to health and social services in the community and elsewhere that include education, rehabilitation and low vision services (as illustrated in Figure 1 below) – all contributing to UHC.

The term ‘allied ophthalmic personnel’ is widely used for this group as a whole and can be used instead of the term ‘mid-level’. Neither mid-level personnel in general nor AOPs specifically exist as occupational groups in ISCO-08. Apart from ophthalmologists and optometrists, dedicated specialist eye care cadres may be included in the ISCO-08 categories of paramedical practitioners, nursing professionals, and medical assistants and technologists (Figure 1). The latter group, who have on-the-job or short-term training to ‘perform basic clinical and administrative tasks to support patient care under direct supervision’, is not very prevalent in sub-Saharan Africa, neither are optical dispensers (3254) or orthoptists (2267). These groups have, therefore, not been included in this process.

The definition of competencies in this document thus pertains to the three main eye health professional groups: ophthalmologists, optometrists and allied ophthalmic personnel (nursing professionals and paramedical practitioners). The rationale for considering the nursing and paramedical practitioners as a single group within AOPs is that allied ophthalmic personnel play varying roles in different countries. Some of the competencies expected of these personnel can be identified as clinical or nursing competencies. In countries without paramedical cadres, in particular, nurses perform many of the tasks traditionally considered to be in the province of paramedics or ophthalmologists.

Countries can, therefore, define which cadres perform these roles and select competencies appropriate to their human resource requirements and structures.


Figure 1: AOPs are a bridge between the community and the ophthalmologist

Ophthalmologists and other specialists in eye or general health care

Paramedical practitioners (2240) surgical technicians

e.g., Ophthalmic clinical officers; non-physician cataract/trichiasis surgeons

Nursing professionals (2221)

e.g., Specialist nurses;ophthalmic nurses

Medical assistants (3256) and others

e.g., Ophthalmic assistants, orthoptists (2267), dispensing opticians (3254), ophthalmic technologists, photographers, and imagers (medical imaging assistants - 5329)

Primary and community health workers link to health and social services

(Figure by Renée du Toit on behalf of the IAPB Human resources for eye health AOP working group)

Thereafter, ISCO-08 referencing and coding for the major categories of eye health professionals was used to assist with further categorization to ensure that these would be globally acceptable (Table 2).

Table 2: International standard classification of eye health professionals

CadreGeneral reference

ISCO - 08 code

Description

OphthalmologistsSpecialist medical practitioners

2212

An ophthalmologist is a medical practitioner who has had specialized post-graduate training in Ophthalmology. Ophthalmologists may further train in subspecialties (not included in this document). They are expected to diagnose, treat (medically and surgically), and prevent eye diseases, ailments and injury, using specialized procedures and techniques, applying principles of modern medicine to deliver comprehensive eye care. They may also diagnose general diseases of the body and treat ocular manifestations of systemic diseases (21-23)

Optometrists Other health professionals

2267

Optometrists and ophthalmic opticians provide diagnosis, management and treatment services for disorders of the eye and visual system. They counsel on eye care and prescribe optical aids or other therapies for visual disturbance.2

Allied ophthalmic personnel

Paramedical practitioners

Nursing professionals

2240

2221

(Source: ILO (2008) International Standard Classification of Occupations (21))

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2 The World Council of Optometry defines optometry as a ‘…health care profession that is autonomous, educated, and regulated (licensed or registered), and optometrists are the primary health care practitioners of the eye and visual system who provide comprehensive eye and vision care, which includes refraction and dispensing, detection or diagnosis and management of disease in the eye, and the rehabilitation of conditions of the visual system.

An optometrist has as a minimum successfully completed a bachelor’s degree or equivalent education from a tertiary level educational institution and is categorized minimally in the category of the Global competency-based model of scope of practice in Optometry* which includes optical technology services, visual function services and investigation, examination and evaluation of the eye and adnexa, and associated systemic factors, to detect, diagnose and manage disease. All other formal or informal cadres that fall below this level (e.g., optometric technicians, optometric assistants, opticians, refractionists) are not entitled to call themselves optometrists’.https://worldcouncilofoptometry.info/wp-content/uploads/2017/03/wco_global_competency_model_2015.pdf


2.3 Organization of the eye health team

The eye health team works in an interdependent manner, with each member strategically assigned specific roles as illustrated in Figure 2. The three eye health professional groups considered in this document: ophthalmologists, optometrists and allied ophthalmic personnel (nursing professionals and paramedical practitioners) practice with a high level of autonomy, as designated by the International Standard Classification of Occupations (ISCO-08) (21). Generalist health care providers at the primary and community level are also a valuable addition to the eye team but are not included here.

Figure 2: Organization of the eye health team; categories and codes from the International Standard Classification of Occupations (ISCO-08). Shaded blocks indicate the eye health professionals to whom this document pertains.

Eye health team (ISCO-08 Classification)

Generalist health careproviders (eye health

competencies included in general training)

Specialist eye health personnel(special or advanced eye health training)

Communitybased

Facilitybased

Facility basedAllied ophthalmic personnel

Communityhealth

workers(3253)

Front line health

workers & primary health care providers

(Ophthalmic)Assistants(Medical assistants

3256)

(Ophthalmic)Nurses(Nurse

professionals2221)

(Ophthalmic)Clinical

officers, etc.(Paramedicalpractitioners

2240)

Optometrists(2267)

Ophthalmologist(Specialist medical

practitioners2212)

(Figure by Renée du Toit on behalf of the IAPB Human resources for eye health working group)

CHAPTER 3

Roles of the Eye Health Workforce


3 In the development of roles and competencies, this document focuses on the largest three eye health professional groups in the eye health team and whose work is largely autonomous: ophthalmologists, optometrists and AOP - the ISCO-08 categories of paramedical practitioners and professional nurses.

3.1 Introduction

The IAPB human resources for eye health working groups identified CanMEDS, a medical education and practice framework, as suitable for adaptation to produce the domains for organizing the eye health competencies. By the end of the process, the 7 CanMEDS roles had been expanded to 10 domains.

The roles of the three eye health professional groups in the eye health team3 have been broadly divided into (a) technical or clinical domains and (b) non-clinical domains. Normally, the different cadres share the non-clinical domains (also called collaborative domains) (Figure 3). The overlap indicates those aspects of the roles that are shared. For example, many of the aspects of ‘communicator’ are relevant to both non-clinical and clinical roles (e.g., using clear, simple non-technical language to explain treatment options to a patient (clinical) or when doing advocacy (non-clinical). Competent eye health care providers integrate the competencies of all the roles into their practice (25).

Figure 3: Domains of the eye health team: clinical and common or shared non-clinical domains

3.2 Common vs unique technical or clinical competencies

The eye health team can also share some clinical or technical competencies (common technical or clinical competencies); however, the competencies may be unique to a group, thus differentiating the work of one group from the work of the other (Figure 4).

3.2.1 ‘Common’ technical or clinical competencies

‘Common’ or shared technical or clinical competencies are those expected of all eye health professionals in the eye team, e.g., taking a history. These can also be seen as competencies that are common or overlapping more than one eye health profession but not necessarily all eye health professions.

In the United Kingdom, overlaps in competencies have been used as a strategy to make the most effective use of professional (but non-medical) members of the eye health team such as optometrists, orthoptists, and ophthalmic nurses. Shared or common competencies of the non-medical eye team are listed at three levels of autonomy:

• Ability to perform clinical work that assists medical decision-making• Ability to follow a protocol with clearly defined delegated decision-making• Ability to make decisions independently with appropriate support and back up.

This enables non-medical members of the eye care team, based on their level of competence, to take on expanded roles to help manage demand and to provide safe and efficient care for patients. This is the rationale for task shifting or sharing (26, 27).

Technical/clinical domains

• Non-surgical care• Surgical care• Preventive and promotive

care• Palliative and rehabilitative

care

Common non-clinicalcollaborative domains

• Communicator• Leader/Manager• Health Advocate• Community Practitioner• Scholar/Researcher/

Teacher/Mentor/Lifelong Learner

• Professional


3.3.2 Unique, ‘complementary’ and technical or clinical competencies

Unique, ‘complementary’ and clinical competencies distinguish one profession from another and complement the competencies of other professions. These individual professional competencies are based on the unique aspects of a professional’s practice, and the profession’s unique body of knowledge, skills, attitudes, and judgments. Ophthalmologists and optometrists, for example, have unique expertise in surgical and refractive care competencies respectively. Likewise, the advanced surgical skills of ophthalmologists enable them to manage complex cases and complement the basic surgical skills of a cataract surgeon. These unique clinical competencies differentiate one profession from the other.

Figure 4: Common non-clinical competencies and clinical competencies that are either common or unique to eye health professional groups

3.3 Technical or clinical domains

The technical or clinical role of the eye health team is to provide comprehensive eye health care that encompasses curative care (assessment and treatment), rehabilitative and palliative care, preventive care, health promotion that is continuous, and high-quality, safe and person-centred care.

3.3.1. Non-surgical care

As curative care providers, the eye health team elicit a history, perform an examination, select appropriate investigations, synthesize and interpret results to inform diagnosis; then, advise on management in collaboration with patients and their families as well as with other health providers, depending on the context.

3.3.2 Surgical care

The eye team works to provide information and counselling about eye surgery and assists patients to access screening, high-quality and safe surgery, and follow-up care. The team obtains consent for invasive procedures, ensures appropriate care and takes measures for infection control in the pre-, peri-, and post-operative phases.

3.3.3 Preventive and promotive care

The eye team counsels patients and their families and provides information to support people to contribute and adhere to management plans, promote eye health, utilize health and social services, support healthy behaviours, and prevent or reduce damage from eye disorders.

Commonnon-clinical

competencies

Clinicalcompetencies

unique tooptometrists

Clinicalcompetencies

unique toallied

ophthalmicpersonnel

Clinical competenciesunique to

ophthalmologists


3.3.4 Palliative and rehabilitative careThe eye health team helps to provide links to an inclusive, supportive environment. It also facilitates access to rehabilitation and low vision care, including optical and non-optical assistive products to optimize use of the remaining vision. Finally, the eye health team helps provide links to services for those who are irreversibly visually impaired. In addition to this, it provides an inter-professional and multidisciplinary approach to resolving the problems of persons with life-limiting illnesses in order to improve quality of life for both the patient and their family.

3.4 Other common non-clinical collaborative domainsThe common or collaborative domains of the eye care team are those that are shared by all the three groups and support teamwork, implementation of technical or clinical roles, and inter-professional or collaborative practice. These include the roles played in Sections 3.4.1 to 3.4.6.

3.4.1 Communicator The eye health team member uses the most effective communication methods to obtain, discuss and share information with patients, their families and everyone involved in the patient’s care. This enables individuals, families and communities to make healthy decisions and become partners in their own health. The aim is also to understand the patients’ situation and expectations, meet their eye health needs, and share with them information for decision-making and goal-setting.

3.4.2 Leader and managerThe team members work effectively with others, including patients and everyone involved in their management such as health care workers, other service providers, community partners, and others in the health system. The aim is to develop relationships based on trust, respect and shared decision-making among and within multidisciplinary teams, and thus, provide broader leadership in the context of health and social development. As a manager, the team member guides the work of colleagues working with him and assists and motivates them to create a healthy and professional work environment. The absolute goal of management is the achievement of high performance by all members of the team. Moreover, the team member plans and works efficiently to deliver eye health using available human and financial resources.

3.4.3 Health advocateThe eye health team members are expected to advocate, in partnership with the community, for increased resources, including workforce allocation for eye health at different levels.

3.4.4 Community practitioner Members of the eye health team are expected to work with the community to ascertain and understand the determinants of health in the physical and social environment, the needs of the community and the potential mechanisms needed to address these. The aim here is to foster good health practices, discourage harmful practices and empower members to harness their own resources and access other available resources.

3.4.5 Scholar-researcher-teacher-mentor-lifelong-learnerA team member is expected to demonstrate a lifelong commitment to excellence in practice by gathering information, evaluating and using evidence, continually evaluating the processes and outcomes of his or her own work and that of the teams in which he or she works, sharing and comparing his or her work with that of others, and actively seeking feedback. There is also the expectation that the team member will help patients and families to self-manage their health by providing training and supportive supervision to other health workers. To improve performance, the team member will be expected to engage in continuing personal development. The overall aim here is to use multiple ways of continuous learning to continuously improve the quality of service, increase responsiveness to patient needs, and ultimately achieve universal access to health.

3.4.6 ProfessionalThe eye health team member is expected to demonstrate accountability to individual patients and society, to the profession and to self through ethical practice, respect for others’ rights, and high personal standards of behaviour. All this indicates the need for dedication to the profession, commitment to the public good, adherence to ethical standards and values such as integrity, honesty, altruism, respect for diversity, and transparency with respect to potential conflicts of interest. The aim is the improved health and well-being of individuals and patient populations.

CHAPTER 4

Competencies for Ophthalmologists


Table 3: Core competencies for an ophthalmologist

CORE COMPETENCIES FOR AN OPHTHALMOLOGIST

Domain Competency statement Competency

Non-surgical care

Conducts patient evaluations

1. Obtains patient history accurately

2. Conducts comprehensive patient evaluations

Synthesizes the information to determine the diagnosis

3. Makes a clinical diagnosis based on the information gathered from the patient

Formulates and implements appropriate management plans

4. Plans management together with patient or guardian and other health professionals with the available information

5. Identifies and manages ophthalmic emergencies and trauma

6. Refers patients as appropriate

7. Manages health information accurately and safely

Surgical care Performs safe surgery8. Performs safe and high-quality surgery

9. Maintains proficiency in standard surgical procedures (Refer to Annex VI(a))

Preventive and promotive care

Provides health promotion to preserve and optimize eye health

10. Counsels patients & families on aspects of their eye health

11. Educates patients and the public on good health practices

12.

Provides advice & educates employers and employees on eye health and protective measures at work and in different social environments

Palliative and rehabilitative care

Facilitates access to comprehensive care and social inclusion

13.

Facilitates access to vision rehabilitation, rehabilitation of the blind, social and educational resources, and periodic re-evaluations

14.Facilitates access to palliative care following a multidisciplinary team approach


Table 4: Components of the competencies for an ophthalmologist and related knowledge, skills and behaviours

DOMAIN 1. NON-SURGICAL CARE: Clinical evaluation, diagnosis and treatment

Competency Knowledge, skills and behaviours

Obtains patient history accurately

Knowledge: General information, including clinical manifestations and epidemiology of all eye diseases, and ocular manifestations of other systemic diseases; basic concepts and communication skills

Skills: Obtains relevant information to identify the patient’s clinical problem

Behaviours: Effective communication with patients, guardians, family members and other health care providers

Conducts comprehensive patient evaluations

Knowledge: General anatomical and physiological functioning of the ocular system; clinical presentation of common eye and systemic disorders, and use of suitable diagnostic procedures

Skills: Evaluates systemic, ocular and visual systems

Behaviours: Uses appropriate diagnostic tools proficiently to do comprehensive evaluations

Makes clinical diagnoses based on the information gathered from the patient

Knowledge: General ophthalmic clinical sciences, including gross ocular anatomy; histology, embryology, physiology, microbiology, pharmacology, biochemistry, refraction and genetics; clinical ophthalmology: principles, practice and clinical presentations

Skills: Makes diagnoses using gathered history, examination findings; thinks critically based on gathered information

Behaviours: Demonstrates ability to synthesize all data and information from history, examination, and investigation; uses findings to systematically make clinical diagnoses

Plans management together with the patient or guardian and other health professionals using available information

Knowledge: Determines the different options available for interventions (medical, surgical or optical, etc.) to resolve an identified problem and follow up outcomes

Skills: Identifies the most appropriate intervention or treatment plan for the patient

Behaviours: Communicates treatment options to enable the patient to make an informed decision

Identifies and manages ophthalmic emergencies and trauma

Knowledge: Possesses a good background in general medical emergencies, and in ophthalmic emergencies, Ocular Trauma

Skills: Identifies general and ophthalmic emergencies; manages ophthalmic emergencies (medical & surgical); refers patients or involves other specialists

Behaviours: Uses clinical judgment and critical appraisal decision-making; Identifies and manages with a sense of urgency;Ensures services are always available to manage emergencies


DOMAIN 1. NON-SURGICAL CARE: Clinical evaluation, diagnosis and treatment

Refers patients as appropriate

Knowledge: Is familiar with the overall scope of ophthalmology, and with the limitations and roles of other health personnel

Skills: Identifies patients requiring further assessment or management

Behaviours: Demonstrates ability to collaborate with other health professionals and clinical experts, and people from different health and non-health sectors; is a team player

Manages health information accurately and safely

Knowledge: Meets ethical and legislative requirements for obtaining, recording, storing, retaining and destroying patient records and other office documentation; has knowledge of the information system and how to analyse information

Skills: Records patient information and data in a legible, secure, accessible, permanent and unambiguous manner; uses electronic records

Behaviours: Maintains confidentiality of patient records

DOMAIN 2. SURGICAL CARE: Performs safe surgery

Performs safe and high-quality surgery

Knowledge: The different surgical options for general or common eye conditions (Annex VI(a)), including emergencies; indications for certain procedures (surgical operations) and alternatives; description of a procedure in a systematic manner (including giving step-by-step explanations); knowledge of different approaches and of post-surgical management, including any anticipated complications; proficiency in follow-up, including referral if needed

Skills: Prepares patients clinically and psychologically for specific procedures; performs standard surgical procedures (Annex VI(a))

Behaviours: Participates in patient assessments; observes and assists senior colleagues in carrying out procedures; accepts to be supervised by senior colleagues; counsels patients on procedures; is proficient in all standard surgical procedures; collects and records data; is proficient in the use of available equipment and instruments; displays the standard procedures and protocols to be used in theatre appropriately for quick reference

Maintains proficiency in all surgical procedures

Knowledge: Is proficient in all surgical procedures; knows the role of clinical audits

Skills: Develops and maintains proficiency in all surgical skills; submits to updating personal skills through self-improvement in new procedures (CPD); performs all surgical procedures within scope (Refer Annex VI(a))

Behaviours: Can perform self-audits; can participate in structured wet lab activities and training; can use simulators and the wet (skills) lab.


DOMAIN 3. PREVENTIVE AND PROMOTIVE CARE: Provide health promotion to preserve and optimize eye health

Counsels patients and families on aspects of their eye health

Knowledge: Is proficient in epidemiology and the natural history of common eye diseases in the Region, including outcomes after seeking early treatment; identifies cultural beliefs and practices around eye health issues

Skills: Breaks communication barriers; effectively communicates to communities and patients to encourage positive health-seeking behaviours and adherence to treatment

Behaviours: Displays a non-judgmental, friendly, attitude, recognizing socio-cultural and patient differences

Educates patients and the public on good eye health practices

Knowledge: Proficient in the basic principles of education and promotive health practices, e.g., hygiene, immunization, and nutrition

Skills: Effectively communicates the benefits of good health practices, avoiding harmful traditional practices

Behaviour: Displays good health habits

Provides advice and educates employers and employees on eye health and protective measures in the workplace and other social environments

Knowledge: Has a mastery of occupational and environmental health; of eye protection, vision and ergonomics

Skills: Improves the workplace environment and cares for protective eye equipment and eye wear

Behaviours: Is supportive, respectful and proactive in preventing eye injuries in the workplace and in different social environments

Domain 4. PALLIATIVE AND REHABILITATIVE CARE: Facilitate access to comprehensive care and social inclusion

Facilitates access to vision rehabilitation; rehabilitation of the blind; social and educational resources; and undertakes periodic re-evaluations

Knowledge: Mastery of the principles of low vision; and of rehabilitation of visually impaired and blind persons

Skills: Identifies patients who need low vision and rehabilitation services

Behaviours: Supports solutions to improve the quality of life in low vision patients in different circumstances; refers patients to appropriate services and re-evaluates them periodically

Facilitates access to palliative care through a multidisciplinary team approach

Knowledge: Is proficient in medicine, ophthalmology and oncology

Skills: Works in a team and communicates effectively

Behaviours: Shows empathy


CHAPTER 5

Competencies for Optometrists


Table 5: Core competencies for an optometrist

CORE COMPETENCIES FOR AN OPTOMETRIST


Non-surgical care

Obtains the relevant patient history

Makes general observations of patients

Obtains case histories

Conducts comprehensive patient evaluations

Formulates examination plans

Implements examination plans

Assesses the ocular adnexa and the eye

Assesses central and peripheral sensory visual

function and the integrity of visual pathways

Assesses refractive status

Assesses oculomotor and binocular function

Assesses visual information processing

Assesses the significance of signs and symptoms

found incidental to ocular examinations in relation

to the patient’s eye or general health

Synthesizes information to determine diagnoses

Interprets and analyses findings to establish

diagnoses

Formulates appropriate management plans

Designs management plans for individual patients

and implements the plans agreed to with the

patients

Prescribes spectacles

Prescribes contact lenses

Manages patients requiring vision therapy

Treats ocular disorders and injuries using

appropriate pharmacological treatment regimens

within the permissible scope or refers patients

appropriately

Dispenses optical prescriptions accurately

Ensures emergency optometric care is available


Surgical careSupports ophthalmologists in pre- and post-operative patient management

Identifies patients that require surgical

management and refers them appropriately

Conducts pre- and post-surgical examinations and

observations in collaboration with a surgeon

Conducts in-theatre objective refraction



Utilizes available resources to enhance patient

outcomes

Provides advice on vision and eye health and takes

protective measures in the workplace and in the

social environment


Facilitates access to low vision services, rehabilitation, and social inclusion

Provides for the care of patients with special

needs

Prescribes low vision devices and non-optical

interventions


Table 6: Components of competencies for an optometrist

Domain 1. NON-SURGICAL CARE: Clinical evaluation, diagnosis and treatment


Makes general observations of patients

Knowledge: Proficiency in the fundamentals of general and gross anatomy of the human body; in normal aspects of gait and posture.

Skills: Observes, recognizes and explores relevant physical and behavioural characteristics of patients

Behaviours: Is observant, perceptive, and investigative

Obtains case histories

Knowledge: In-depth knowledge of the biomedical, visual, and clinical sciences; of clinical optometry, relevant clinical ophthalmology, common problems encountered in health care with emphasis on ocular manifestations

Skills: Breaks communication barriers; elicits relevant history from patients

Behaviours: Has inter-personal rapports and understanding; is an active listener and shows empathy

Formulates examination plans

Knowledge: In-depth knowledge of the biomedical, visual & clinical sciences; of clinical optometry and relevant clinical ophthalmology; of structured clinical optometric evaluations and procedures

Skills: Organizes and interprets information; conducts selective or oriented assessments and diagnostic tests

Behaviours: Is an analytical and critical thinker; is flexible

Implements examination plans

Knowledge: Has a general understanding of eye health systems; clinical optometry; relevant clinical ophthalmology; structured clinical optometric evaluations and procedures

Skills: Conducts clinical ophthalmic or optometric tests and procedures; is conversant with standard precautions

Behaviours: Is proficient, confident and secure in using available tools to perform tests

Assesses the ocular adnexa and the eye

Knowledge: Has in-depth knowledge of gross human and ocular anatomy and physiology; of the function of the ocular adnexa, and of relevant ocular pharmacology

Skills: Can evaluate the external anatomical structure of the eye and how it functions

Behaviours: Is observant, demonstrates a clear understanding of normal from abnormal structures; is culturally sensitive

Assesses central and peripheral sensory visual function and the integrity of visual pathways

Knowledge: Has in-depth knowledge of the biomedical and (neuro) visual sciences; has a general understanding of eye health systems, clinical optometry, relevant clinical ophthalmology, and clinical optometric procedures

Skills: Can test for comprehensive visual functions

Behaviours: Can conduct various optometric assessments with confidence; is analytical in interpretation of test outcomes




Assesses refractive status

Knowledge: Has in-depth knowledge of the biomedical and (neuro) visual sciences; has a general understanding of eye health systems; of clinical optometry; relevant clinical ophthalmology; clinical optometric procedures; ocular and diagnostic pharmacology

Skills: Can determine the refractive status of the eye (subjectively and objectively); can use relevant pharmacological agents to establish refractive status

Behaviours: Has proficiency in using tools for and conducting refractive testing, e.g., the use of retinoscopes, ophthalmoscopes, refraction bars, autorefractors

Assesses oculomotor and binocular function

Knowledge: Has in-depth knowledge of the biomedical, visual, and clinical sciences; has a general understanding of eye health systems; clinical optometry, relevant clinical ophthalmology, clinical optometric procedures

Skills: Can identify abnormal oculomotor functions and conduct orthoptic assessments; can test binocular vision

Behaviours: Is analytical in interpretations of test outcomes; is proficient, confident, adaptable, and culturally sensitive

Assesses visual information processing

Knowledge: Has in-depth knowledge of the biomedical and (neuro) visual sciences; has a general overview of eye health systems, clinical optometry, relevant clinical ophthalmology, clinical optometric procedures, visual information processing, development milestones, and learning problems; is conversant with image fusion, binocular single vision, and stereopsis

Skills: Can use visual processing assessment tools

Behaviours: Is proficient in using different tools; is observant and analytical

Assesses the significance of signs and symptoms found incidental to ocular examinations in relation to the patients’ eye or general health *

Knowledge: Has in-depth knowledge of the biomedical, visual and clinical sciences; has a general overview of eye health systems, clinical optometry, relevant clinical ophthalmology, clinical optometric procedures, and common systemic diseases

Skills: Can recognize and act on incidental clinical findings

Behaviours: Is an analytical and critical thinker; is proactive with referrals

Interprets and analyses findings to establish diagnoses

Knowledge: Has in-depth knowledge of the biomedical and visual sciences; has a general overview of eye health systems, clinical optometry, relevant clinical ophthalmology, ocular pharmacology, and clinical optometric procedures

Skills: Can analyse, synthesize and correlate clinical findings

Behaviours: Can analyse, reflect on and use all clinical and diagnostic findings




Designs management plans for individual patients and implements the plans agreed to with the patients

Knowledge: Knows available clinical interventions and management options; is conversant with the course and prognosis of conditions; follows best practice

Skills: Can formulate appropriate patient-centred management plans

Behaviours: Reasons deductively; is problem-oriented; has clinical judgment; communicates well with patients and their families

Prescribes spectacles

Knowledge: Has in-depth knowledge of refraction and the visual sciences; is conversant with refractive correction modalities, binocular status, prescribing indications and philosophies, appliance and lens modalities and adjustments

Skills: Can determine optical prescriptions based on individual patient needs

Behaviours: Is understanding, empathic, supportive, flexible, culturally sensitive, and respectful; assists patients in the use of spectacles

Prescribes contact lenses *

Knowledge: Has in-depth knowledge of refraction, binocular status, prescribing indications and philosophies, biomedical, visual and clinical optometry sciences, contact lens modalities, contact lens indications, contra-indications, maintenance, and complications

Skills: Can accurately determine contact lens fit and modality based on individual patient status and visual requirements

Behaviours: Is understanding, empathic, and supportive; can confidently assist patients who use contact lenses

Manages patients requiring visiontherapy *

Knowledge: Has in-depth knowledge of the biomedical and visual sciences; has an overview of eye health systems, clinical optometry, relevant clinical ophthalmology, clinical optometric procedures, and oculomotor and binocular vision; is conversant with the different approaches to vision therapy

Skills: Can manage binocular vision anomalies using vision therapy

Behaviours: Can critically appraise and analyse situations; can reason deductively and make clinical judgments; can support patients optimize residual vision; can offer vision therapy

Treats ocular disorders, diseases and injuries using appropriate pharmacological treatment within the permissible scope or refers patients appropriately regimens.

Knowledge: Has in-depth knowledge of the biomedical and visual sciences; has an overview of eye health, clinical optometry, relevant clinical ophthalmology, pharmacology, therapeutic pharmacology, basic anatomy and the physiology of the eye

Skills: Can select appropriate pharmacological agents for the treatment of patient disorders within the scope of practice (Annex VI(b))

Behaviours: Can critically appraise and analyse situations; reasons deductively; exercises clinical judgment; manages creatively and is always ready to refer; can self-evaluate; is confident and recognizes personal and legal limitations




Dispenses optical prescriptions accurately

Knowledge: Has in-depth knowledge of the principles of vision and refractive status, ophthalmic optics, characteristics of spectacles, and the anatomy of the head and neck; is conversant with basic visual ergonomics

Skills: Can interpret spectacle prescriptions according to patient needs; can fit spectacles

Behaviours: Is understanding, empathic, supportive, and confident when communicating

Ensures emergency optometric care is available

Knowledge: Has in-depth knowledge of the biomedical and visual sciences; has a general overview of eye health systems, clinical optometry, relevant clinical ophthalmology, and clinical optometric procedures; can manage emergencies in optometry

Skills: Can plan or organize for emergency optometric services; can identify optometric and other medical emergencies

Behaviours: Shows empathy with patients in distress; allows needed use of time; employs a flexible management approach; reports optometric emergencies; refers other medical emergencies; is understanding, supportive, flexible, and culturally sensitive


Knowledge: Has deep knowledge of the ethical and legislative requirements for obtaining, recording, storing, retaining and destroying patient records and other office documentation; is knowledgeable about information systems

Skills: Can record patient information and data in a legible, secure, accessible, permanent, and unambiguous manner, including in electronic format

Behaviours: Can maintain confidentiality of patient records

DOMAIN 2. SURGICAL CARE: Support of ophthalmologists in pre- and post-operative management of patients


Identifies patients that require surgical management and refers them appropriately

Knowledge: Has in-depth knowledge of the biomedical, visual and clinical sciences; of general eye health and referral systems; of clinical optometry, relevant clinical ophthalmology, clinical optometric procedures, and of available surgical options

Skills: Can identify and refer patients who need surgery

Behaviours: Can make critical appraisals and analyses; exudes confidence and is adaptable; can take decisions; recognizes personal and legal limitations; is a team player

Conducts pre- and post- surgical examinations and observations in collaboration with a surgeon

Knowledge: Has in-depth knowledge of the biomedical and visual sciences; has a general overview of eye health systems, clinical optometry, relevant clinical ophthalmology, clinical optometric procedures, available surgical options; can determine pre-operative indications and requirements, and manage post-operative outcomes

Skills: Can evaluate selected patients before and after surgical procedures; can take standard precautions

Behaviours: Is proficient, confident, flexible and ethical; can maintain inter-professional rapport


DOMAIN 2. SURGICAL CARE: Support of ophthalmologists in pre- and post-operative management of patients


Conducts in-theatre objective refractions

Knowledge: Has in-depth knowledge of refraction and the visual sciences; has knowledge of refractive assessments and correction modalities; and of prescribing indications and philosophies

Skills: Performs objective refraction to determine patient refractive status and manage accordingly

Behaviours: Shows proficiency and confidence in both objective and subjective refraction

DOMAIN 3. PREVENTATIVE AND PROMOTIVE CARE: Provide health promotion to preserve and optimize eye health


Utilizes available resources to enhance patient outcomes

Knowledge: Knows the functions of and resources available from optometric and other organizations; the roles of organizations and government bodies such as health ministries, registration authorities, and professional associations

Skills: Understands and can use available resources; can appraise information; understands local health and eye health systems

Behaviours: Is understanding, supportive and resourceful; can collaborate with other team members and cross-sectoral services

Provides advice on vision and eye health and takes protective measures in the workplace and the social environment

Knowledge: Has in-depth knowledge of refraction, the visual sciences, refractive correction modalities, binocular status, occupational and environmental optometry, eye protection and visual ergonomics, vision standards, disability-friendly environments

Skills: Improves home and institutional environments to maximize vision and comfort

Behaviours: Is understanding, empathic, supportive, confident, flexible, culturally sensitive, and respectful; is proactive in preventing eye injuries at the workplace or in different social environments

DOMAIN 4. PALLIATIVE AND REHABILITATIVE CARE: Contribute to and facilitate access to low vision services, rehabilitation and social inclusion


Provides for the care of patients with special needs

Knowledge: Has in-depth knowledge of the biomedical and visual sciences; has a general overview of eye health systems, clinical optometry, basic ophthalmology, and clinical optometric procedures; is conversant with inclusive eye care.

Skills: Can identify patients with special needs

Behaviours: Is understanding, empathic, supportive, confident, flexible, culturally sensitive, and respectful


DOMAIN 4. PALLIATIVE AND REHABILITATIVE CARE: Contribute to and facilitate access to low vision services, rehabilitation and social inclusion


Prescribes low vision devices and non-optical interventions

Knowledge: Has in-depth knowledge of refraction, the visual sciences, the classification of visual impairment and low vision, low vision management options, and indications for rehabilitation services

Skills: Conducts patient-centered low vision assessments;communicates low vision needs of patients; can collaborate with other players

Behaviours: Is understanding, empathic, supportive, confident, flexible, culturally sensitive, respectful, and patient; assists patients with low vision devices

(Refer to Annex VI(b)) *

CHAPTER 6

Core Competencies for Allied OphthalmicPersonnel


Allied ophthalmic personnel play varying roles in different countries. Some of the competencies expected of these staff can be identified as clinical or nursing competencies, or both. Countries can define which cadres perform these roles and select competencies appropriate to their human resource requirements and structures.

Table 7: Core competencies for allied ophthalmic personnel

CORE COMPETENCIES FOR ALLIED OPHTHALMIC PERSONNEL


Non-surgical care

Conducts patient evaluations

1. Creates a welcoming and patient-friendly environment

2. Obtains relevant patient history

3. Conducts basic patient clinical examinations and investigations

Synthesizes the information to determine a diagnosis

4. Makes diagnoses based on information gathered from the patient and knowledge in the ophthalmic clinical sciences

Formulates and implements management plans

5. Plans treatment together with the patients or their guardians and other health professionals using the available information

6. Develops appropriate management and care plans for ophthalmic medical patients

7. Administers medications relevant to eye care

8. Recognizes and refers patients as required

9. Manages health information accurately and safely

Surgical care Works with ophthalmologists in the provision of safe surgery

10. Identifies and assesses patients for surgery

11. Obtains consent for treatments and surgery

12. Prepares patients for surgical procedures and treatment

13. Ensures infection prevention; ensures that aseptic techniques are observed

14. Assists in providing safe surgery by facilitating implementation of standards and safety measures

15. Administers local anaesthesia for cataract, glaucoma and other intraocular procedures

16. Performs minor surgery (**Annex VI(a))

17. Performs cataract surgery according to skill level (**Annex VI(a))

18. Manages ophthalmic wounds

19. Develops management plans for the care of ophthalmic surgical patients

20. Assesses and manages pain

21. Manages and refers post-operative complications as appropriate



22. Counsels patients and their families on aspects of their eye health

23. Educates patients on good health practices

24. Plans and participates in community health promotion and education activities


CORE COMPETENCIES FOR ALLIED OPHTHALMIC PERSONNEL



Facilitates access to comprehensive care and social inclusion

25. Conducts basic low vision assessments and assist in the use of assistive products

26. Facilitates and follows up access to rehabilitation and social inclusion

27. Refers patients appropriately

Table 8: Components of the competencies for allied ophthalmic personnel

DOMAIN 1. NON-SURGICAL CARE: Clinical evaluation, diagnosis, treatment and care

Competency statementKnowledge, attitudes and skills required to demonstrate core competencies

Creates a welcoming and patient friendly environment

Knowledge: Basics of the cultural context; management of common eye diseases; technical procedures carried out at different levels of care and expected outcomes

Skills: Effective use of relevant information to identify patient clinical problems

Behaviours: Effective communication

Obtains relevant patient history

Knowledge: Basic information in epidemiology and clinical presentation of common eye diseases

Skills: Effective use of relevant information to identify the patient clinical problems

Behaviours: Interpersonal and communication skills; readiness to discuss with patients and guardians; interaction with eye care team; ability to read communications or talk to other professionals to improve skills

Conducts basic patient clinical examinations and investigations

Knowledge: Knowledge of gross anatomical and physiological functioning of the ocular system

Skills: Use of appropriate tools and equipment (including laboratory tools and equipment) to examine the anatomical and physiological functioning of the ocular and visual systems

Behaviours: Appraisal and utilization of appropriate tools and laboratory services

Makes diagnoses based on information gathered from the patient and knowledge in the ophthalmic clinical sciences

Knowledge: Basic ophthalmic clinical sciences, including ocular anatomy, embryology, physiology, microbiology, pharmacology, biochemistry, and refraction

Skills: Ability to point to a provisional diagnosis using data gathered from evaluation and knowledge of ophthalmic clinical sciences

Behaviours: Use of clinical, laboratory and other data to make diagnoses

Plans treatments together with the patients or their guardians and other health professionals using available information

Knowledge: Available options for interventions (medical, surgical, optical, etc.) where they can be sourced; outcomes of the identified problems or diagnoses

Skills: Identify and administer the best treatment option for the patient

Behaviours: Analyze previous treatment options and outcomes where available


DOMAIN 1. NON-SURGICAL CARE: Clinical evaluation, diagnosis, treatment and care


Develops appropriate management and care plans for ophthalmic medical patients

Knowledge: Basic anatomy, physiology and pathology of eye diseases;clinical presentations and treatment (medical or surgical) of common eye diseases

Skills: Develop and execute nursing treatment and care plans for patients who have undergone medical and surgical eye care

Behaviours: Share care plans with the eye care team; ensure seamless patient flow

Administers medications relevant to eye care

Knowledge: Basic ocular system: anatomy, physiology, microbiology and pharmacology; basic essential medicine principles; practical considerations in the administration of oral, parenteral, eye drops and ointments, including undesirable effects and possible allergic reactions; proper storage of medications

Skills: Correct drug administration techniques

Behaviours: Demonstrate safe and professional management of drugs and other medical products; educate patients on their drug therapy, including patient self-administration of eye preparations and their storage

Recognizes and refers patients as required

Knowledge: Scope of practice of AOP; their limitations; role of other health personnel; knowledge of the referral pathways in the country

Skills: Identify when treatment options do not give optimal outcomes due to limited scope (personnel skills or facilities); triage

Behaviours: Willingness to collaborate with other higher-level health professionals (members of the team) or clinical experts; team players in ophthalmology, including social services and education


Knowledge: Ethical and legislative requirements in obtaining, recording, storing, retaining and destroying patient records and other office documentation

Skills: Record patient information and data in a legible, secure, accessible, permanent and unambiguous manner, including in electronic records

Behaviours: Maintain confidentiality of patient records

DOMAIN 2. SURGICAL CARE: Work with ophthalmologists in the provision of safe surgery


Identifies and assesses patients for surgery

Knowledge: The different surgical options for common eye conditions in the Region; pre-operative requirements and criteria for the different surgical procedures

Skills: Perform standard pre-op assessments for general and common surgical procedures; use diagnostic equipment and tools for assessment;counsel patients on the details of surgical procedures

Behaviours: Demonstrate confidence in clinical assessments and communication; ensure that all equipment needed for assessments are in good working order




Obtains informed consent for treatments or surgery

Knowledge: Knowledge of procedures, processes, and outcomes of all ophthalmic surgical and medical treatments; and of ethical principles

Skills: Counsel patients for different ophthalmic procedures; explain to patients the processes and outcomes of treatments

Behaviour: Demonstrate good communication skills; assist patients to freely make informed decisions and give informed consent

Prepares patients for surgical procedures or treatment

Knowledge: Basic anatomy, physiology and pathology of eye diseases; clinical manifestations and treatment (medical or surgical) of common eye diseases; principles and practices of ophthalmic surgery; practical aspects of pre- operative preparation in ophthalmic surgery, including basic visual assessment

Skills: Prepare the patients for different surgical procedures or treatments

Behaviours: Assist and participate in all surgical and medical ophthalmic procedures

Ensures infection prevention and ensures that aseptic techniques are observed

Knowledge: Basic ocular anatomy, physiology, microbiology, pharmacology;principles and practice of aseptic techniques, including hand hygiene; standard infection prevention; safety strategies, including the different processes of disposal, decontamination, disinfection and sterilization

Skills; Provide sterile and safe working environments for the eye care team; development of surgical safety checklists

Behaviours: Practice of aseptic techniques; safe waste disposal; conduct of continuous safety checks before, during, and after surgery;report unexpected outcomes

Assists in providing safe surgery by facilitating implementation of standards and safety measures

Knowledge: Basic anatomy, embryology and physiology of the eye; different surgical options for general or common eye disorders;theoretical and practical (descriptions) steps in the different surgical procedures;instruments and machines used for different procedures

Skills: Assess capacity and readiness for specific surgical procedures

Behaviours: Display appropriately for quick reference standard procedures and protocols to be used in the theatre; report unexpected outcomes

Administers local anesthesia for cataract, glaucoma and other intraocular surgical procedures

Knowledge: Detailed anatomy of the eye orbit and its contents; pharmacology of available local anesthetics; critical risks and events

Skills: Infiltrate local anesthetic solutions or instill topical anesthesia appropriately and safely; monitor patients during and after administration of local anaesthesia

Behaviours: Confident while administering local anesthesia




Performs minor surgery(Refer to Annex VI(a))

Knowledge: Detailed anatomy, embryology, physiology and pathology of the ocular adnexa

Skills: Perform minor extra-ocular surgical procedures

Behaviour: Demonstrate proficiency in the extra-ocular procedures

Performs cataract surgery according to skill level (Refer to Annex VI(a))

Knowledge: Detailed anatomy, embryology and physiology of the eyeball and orbit (including the lens); ageing; complications of cataract surgery, including posterior capsule opacification; the physics and functioning of lasers

Skills: Perform cataract surgery and manage complications

Behaviours: Use of wet-lab facilities to maintain and improve on skills;demonstration of proficiency in cataract surgery

Manages ophthalmic wounds

Knowledge: Basic ocular anatomy, physiology, microbiology, and pharmacology; infection prevention; practical aspects of wound asepsis and healing

Skills: Ability to dress, pad and bandage the eye

Behaviours: Demonstrate sterile and adequate techniques during management of eye disorders

Develops appropriate management plans for care of ophthalmic surgical patients

Knowledge: Basic anatomy, physiology, and pathology of eye diseases; clinical manifestations and treatment (medical and surgical) of common eye diseases

Skills: Develop and execute nursing treatments and care plans for patients who have undergone medical or surgical eye care

Behaviours: Share care plans with the eye care team; ensure seamless patient flow

Assesses and manages pain

Knowledge: Causes of pain after different surgical procedures; principles of pain management in ophthalmology after surgery

Skills: Administer and interpret pain scoring scales; manage pain

Behaviours: Recognize, empathize, and manage patients in pain

Manages and refers post-operative complications as appropriate

Knowledge: Possible complications of different surgical procedures; principles of minor complications in ophthalmology after surgery; knowledge of referral systems

Skills: Manage minor complications as appropriate; refer patients

Behaviours: Recognize and empathize with patients; willingness to collaborate with other higher-level health professionals


DOMAIN 3. PREVENTIVE AND PROMOTIVE CARE: Provide health promotion to preserve and optimize eye health


Counsels patients and their families on aspects of their eye health

Knowledge: The natural history of common eye diseases, including outcomes after seeking early treatment; cultural beliefs and practices surrounding eye health issues

Skills: Effectively counsel patients and families to encourage, positive health- seeking behaviours and adherence to treatment; support patient self-management, especially for people at risk or requiring long or lifetime care

Behaviours: Display a non-judgmental, friendly, attitude; recognize socio-cultural and patient factors

Educates patients on good health practices

Knowledge: Basic principles of health education and promotive health practices, e.g., hygiene, immunization, and nutrition

Skills: Effectively communicate the benefits of good health practices; avoid harmful practices

Behaviours: Acknowledge and display good health practices

Plans and participatesin community healthpromotion and education activities

Knowledge: Basic epidemiology of common eye diseases; principles of planning; diagnosis and dialogue within the community; community engagement and mobilization; theories, principles and concepts of communication

Skills: Effectively communicate eye health issues to the communities

Behaviours: Display interpersonal skills; participate in community eye health promotion and education activities in a spirit of collaboration with other professional communicators

DOMAIN 4. PALLIATIVE AND REHABILITATIVE CARE: Facilitate access to comprehensive care and social inclusion


Conducts basic low vision assessments and assist in the use of assistive products

Knowledge: Categories of visual impairment; definition of low vision; basic knowledge of refraction; optical and non-optical support for low vision; patients with different eye disorders

Skills: Conduct basic (but not limited to) low vision assessments;identify and manage low vision and refer patients appropriately

Behaviours: Support in providing basic solutions to improve quality of life in low vision patients under different circumstances; assist patients to use basic low vision assistive products appropriately

Facilitates and follows up access to rehabilitation and social inclusion

Knowledge: Required rehabilitation services, where available; and integrated and special needs schools

Skills: Identify needs and refer patients for rehabilitation or special placement

Behaviours: Work with other non-technical members of the eye health team;communicate rehabilitation needs appropriately; advise, support and empower families to utilize services and engage in inclusive education


CHAPTER 7

Common Non-Clinical Core Competencies for the Eye Health Workforce


Table 9: Common non-clinical core competencies for the eye health team

NON-CLINICAL CORE COMPETENCIES FOR THE EYE HEALTH WORKFORCE


Communicator

Obtains, discusses, and shares information with patients, their families, and everyone involved in caring for the patient

Communicates effectively with the health care team, the patients, their families, the community, and other relevant stakeholders

Uses relevant communication principles to improve patient eye care

Leader and manager

Provides leadership in the delivery of quality eye care

Provides guidance to promote teamwork and collaboration, good work-life balance, and a healthy workplace environment

Promotes quality person-centred integrated eye care services

Develops multidisciplinary relationships and partnerships to promote quality, people-centred, and integrated eye care services

Facilitates opportunities for community eye health services in all sectors

Participates in inter-professional health care activities at all levels

Manages available resources for the effective delivery of quality eye care

Manages available resources in a way that facilitates the work of the eye health team in the delivery of services

Health advocate Promotes change at the policy and community level

Advocates for relevant policy changes

Uses available policies for district planning and implementation of eye care plans

Community practitioner

Participates in community development programmes

Conducts and appropriately presents community needs assessments

Scholar, researcher, teacher, mentor, and lifelong learner

Maintains and enhances knowledge and skills through lifelong learning; adopt best practices and standards through the evidence-based approach

Performs comprehensive clinical interventions, audits, and reviews

Engages in research

Promotes, plans and facilitates lifelong learning, including continuing professional development

Professional

Acts in accordance with the legal framework and professional standards of public good ethical behaviour and practice, commitment and accountability

Practices within the existing national legal framework governing general and eye care practice

Practices in accordance with professional ethics and code of conduct

Adheres to human rights tenets and maintains human dignity

Maintains a good work-life balance


Table 10: Components of the common non-clinical competencies for the eye health team

DOMAIN 5. COMMUNICATOR:Obtain, discuss and share information with patients, their families and everyone involved in caring for the patient

Competency statement

Knowledge, attitudes and skills required to demonstrate core competencies

Communicates effectively with the health care team, patient, family, community and other relevant stakeholders

Knowledge: Theories, principles, concepts, and methods of effective communication and conflict resolution

Skills: Communicates clearly using language appropriate to the person(s) with whom he or she is communicating; uses effective written, verbal and non-verbal communication; has active listening skills

Behaviours: Displays mediation and interpersonal skills; provides feedback; is friendly, empathetic and respectful; collaborates with other professions

Uses relevant communication principles to improve patients eye care

Knowledge: Theory and principles of social and behavioural change communication (SBCC) (Ref. Annex SBCC)

Skills: Applies the components of SBCC; is conversant with communication techniques; follows appropriate channels

Behaviours: Communicates and collaborates with other professionals

DOMAIN 6. LEADER AND MANAGER: Provide leadership, develop multidisciplinary relationships and partnerships, manage available resources to deliver quality people-centred and integrated eye care services



Provides guidance to promote teamwork and collaboration, good work-life balance, and a healthy workplace environment

Knowledge: Principles, concepts, and practices in leadership and organizational management; concept of work-life balance, and of healthy workplace environments; time management strategies

Skills: Has communication and interpersonal skills; knows how to demonstrate support for eye care team; has time management skills

Behaviours: Guides, supports, delegates, motivates, and inspires the eye health team to work together effectively and within a healthy work environment; maintains adequate work-life balance

Promotes quality person-centred integrated eye care services

Knowledge: Health systems concepts and approaches; integrated patient- centred health care concepts; continuous quality improvement strategies

Skills: Prioritizes, and plans to continually improve quality care and maintain the continuum of care

Behaviours: Sets priorities; participates with and supports other team members; is a facilitator

Facilitates opportunities for community eye health services in all sectors

Knowledge: Role of government ministries and other partners in health at all levels; national and local planning cycles and timing; principles of good partnerships and relevant stakeholder engagements

Skills: Identifies opportunities for partnerships; can mobilize resources; can write proposals

Behaviours: Participates in joint fora; initiates partnerships for eye health


DOMAIN 6. LEADER AND MANAGER: Provide leadership, develop multidisciplinary relationships and partnerships, manage available resources to deliver quality people-centred and integrated eye care services



Participates in inter-professional health care at all levels

Knowledge: Understands the role of other health care providers in eye health

Skills: Communicates effectively for inter-disciplinary eye care case management

Behaviours: Promotes cross-sectoral cooperation; participates in joint patient care

Manages available resources in a way that facilitates the work of the eye health team in the delivery of services

Knowledge: Management principles for financial and human resources, including management of infrastructure (buildings and equipment) and logistics; interpersonal skills

Skills: Can plan and monitor budgets; delegates appropriately; practises preventive maintenance of equipment

Behaviours: Works effectively with the management team

DOMAIN 7. HEALTH ADVOCATE: Promote change at the policy and community level



Advocates for relevant policy changes

Knowledge: Knowledge of sources of information relevant to UHC; national, international, and global health and eye health policies; monitoring and evaluation of eye health programmes; epidemiological and communication needs assessment data; their importance for future planning; principles governing the integration of eye health in the health system Skills: Strategic communication; other advocacy skills with health and other political administrative leaders; ability to do advocacy planning; interpersonal skills

Behaviours: Is sensitive, assertive, objective and a good listener when advocating for eye health

Uses available policies for district planning and implementation of eye care plans

Knowledge: Sources of relevant information; national, international, and global health and eye health policies; monitoring and evaluation of eye health programmes; epidemiological and communication needs assessment data; principles governing the integration of eye health in the health system

Skills: Gathers, analyses and uses evidence to develop eye care plans at national, district and community levels

Behaviours: Contributes and collaborates


DOMAIN 8. COMMUNTY PRATICTIONER: Participate in community development



Conducts and appropriately presents community needs assessments

Knowledge: Basic tenets of participatory community practice; quantitative and qualitative methods of data collection (e.g., for action research)

Skills: Conducts community needs assessments; disseminates findings to stakeholders; uses findings to inform planning of community programmes, or for formulating advocacy strategies

Behaviours: Supports community members to identify needs and solutions in a respectful and culturally sensitive manner

DOMAIN 9. SCHOLAR, RESEARCHER, TEACHER, MENTOR AND LIFELONG LEARNER: Maintain and enhance knowledge and skills through lifelong learning and adopt best practice standards through the evidence-based approach



Performs comprehensive interventions, audits, and reviews

Knowledge: Clinical audit processes and cycles; information gathering methods; change management; concepts of reflection and self-regulation; the ‘no blame’ culture

Skills: Ability to conduct audits and to use gathered information for continued improvement

Behaviours: Performs audits, examines outcomes, and facilitates constructive quality improvement processes; embraces change processes

Engages in research

Knowledge: Basic principles of research, research methods, biostatistics, epidemiology, participatory research, general public health; concepts and approaches; evidence-based practice; principles of ethical research

Skills: Ability to establish research concepts and protocols; adherence to ethical principles; ability to implement research protocols; interpretation and utilization of research results; results dissemination skills

Behaviours: Can initiate or participate in research; complies with ethics in research; respects contributors; disseminates and uses research findings

Promotes, plans or facilitates lifelong learning, including continuing professional development

Knowledge: Adult learning theories; principles and processes of continuing professional development (CPD), including mentoring; current developments and advances in eye health; different learning modes, including e-learning

Skills: Aptitude in teaching, mentoring and learning; ability to use different teaching and learning platforms; ability to maintain personal professional development

Behaviours: Facilitates an environment conducive to adult learning; demonstrates patience and flexibility with diverse groups; is a mentor and provides supportive supervision and feedback


DOMAIN 10. PROFESSIONAL: Acts in accordance with professional standards; stays within the legal framework; follows good ethical behaviour and practice; is sworn to commitment and accountability



Practises within the existing national legal framework for general and eye care practice

Knowledge: Laws and regulations in general and eye care practice, including organ donation and data protection and sharing

Skills: Ability to interpret and apply laws and regulations; ability to adhere to existing rules and regulations

Behaviours: Conforms to regulations and legal processes; acts with integrity and transparency; maintains high professional standards

Practises in accordance with professional ethics and code of conduct

Knowledge: Understanding of relevant professional ethics and code of conduct

Skills: Ability to act according to an ethical and professional code of conduct

Behaviours: Observes professional ethics and complies with the code of conduct; acts with integrity; recognizes the limits of his or her own competence

Adheres to human rights tenets and maintains human dignity

Knowledge: Basic human rights tenets: gender equity, child protection, social inclusiveness, diversity, cultural sensitivity

Skills: Ability to apply human rights tenets in practice

Behaviours: Observes human rights in professional behaviour, including tolerance, respect, social inclusion, and cultural sensitivity; preserves patient dignity

Maintains a work-life balance

Knowledge: Concepts of socialization, including work-life balance and healthy workplace environment; understands time management strategies

Skills: Ability to plan, prioritize and apply work-life balance and self-care skills

Behaviours: Displays a healthy and balanced life

CHAPTER 8

Implementation


The eye health competency framework provides a standard base from which WHO and its partners can engage a regional response to improve eye health services in countries over time. The implementation of eye health competencies embraces the principles of (a) partnership: working collaboratively with relevant partners to enhance eye health in the Region; (b) relevance: promoting the adoption or adaptation of the competencies in a way that responds to the context of the African Region; (c) ownership: engaging relevant partners as they implement, monitor, and evaluate them; (d) people-centeredness: taking into account the needs of the population and responding in an equitable and fair manner, while showing respect for gender and human rights.

CollaborationJoint efforts in scaling up education and training for the health workforce is one of the six strategic areas in the African roadmap in this area. At the same time, promoting and sharing education and training capacities in the Region (9) is critical. Proposed interventions include promoting and facilitating the harmonization of curricula, educational standards, accreditations, and professional regulations. The interventions will fully support the realization of the Global Strategy on Human Resources for Health: Workforce 2030 since it is a core mandate of WHO to facilitate and share best practices, provide technical support to the health workforce and broaden the scope of different cadres (24).

Supporting documentsAdaptation and assessment tools are some of the other supporting documents that are envisaged. These tools will be crucial for generating and documenting best practices and lessons learnt. Countries are encouraged to take the present eye health competencies into account when developing their respective guides for training, policy, advocacy, etc. For its part, the WHO Regional Office for Africa will strive to:

• Provide technical assistance for capacity building• Mobilize partners to provide support to improve eye health training• Generate and document lessons learnt, in collaboration with partners.


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44 | Core Competencies for the Eye Health Workforce in the WHO African Region44 | Core Competencies for the Eye Health Workforce in the WHO African Region

Annexes Annex I: PROCESS FOR DEVELOPING CORE COMPETENCIES FOR THE EYE HEALTH WORKORCEA standard process for developing core competencies for the eye health workforce was followed (Figure 5).

Overall aim The overall aim was to produce core competencies for an eye health workforce (ophthalmologists, optometrists, and allied ophthalmic personnel) for the WHO African Region.

Method A collaborative and consultative method was followed. The product from the extensive consultations between 2013 and 2016 that were held among IAPB human resources for eye health (HReH) groups, national eye care coordinators, subject experts from training institutions, professional and regulatory bodies, among others, was used to start the work by WHO. The rest of the WHO-led expert consultations comprised a series of meetings and workshops, Delphi surveys, separate subject-expert meetings of stakeholders between 2017 and 2018. Although the focus was Africa, experts from other continents were also engaged.

The initial Process IAPB laid the appropriate groundwork for the process by initiating identification of the various workforce groups in the eye health team. IAPB specified not only the relationship between these workforce groups and ISCO-08 but also how tasks and roles should conform with international classifications. The format and flow of the CanMEDS framework (Royal College of Physicians of Canada) made it the most appropriate model to be selected for the process. This was followed by development of the first model draft of the tasks and activities of the corps of ophthalmic clinical officers (OCOs). The other cadres were to use a similar framework based on the nine priority areas of the Ouagadougou Declaration on primary health care and health systems. Tasks related to priority areas for eye health, (curative, preventive, promotive and rehabilitative, throughout the life course), were included.

WHO formal technical processA formal collaborative arrangement between WHO Regional Office for Africa (AFRO) and IAPB-Africa was formalized through a concept note to WHO in 2014. It was recommended that only eye health professional groups be included in this process at this stage.

Draft and documentationThe consultant who was recruited produced the first draft using the content of the initial work developed by the IAPB -HReH task groups and the updates information coming from the scientific literature review. This draft was then developed using WHO framework of domains and eye health tasks. The tasks so developed were shared among the rapporteurs in each of the IAPB-HReH task groups for feedback.

Literature searchSources of information from which to draw the competencies were identified and included. These comprised existing curricula from training institutions, documents from professional bodies in Africa and outside the continent, and national and global policy documents and publications, including the International Standard Classification of Occupations and relevant Regional Office documentation.

Consensus building and consultationsThe WHO recruited consultant with the financial support of IAPB to draft the document by literature search, reviewing the concept note and competencies, developing tools and conducting Delphi surveys in the WHO African Region to build expert consensus (Annex V). A modified Delphi process was used to reach consensus on the essential core competencies required of the eye health workforce. Delphi participants were selected from the IAPB database of training institutions in Africa, virtual colleges, COECSA, RCOphth, ICO, NGOs in eye health, policy makers, national eye care coordinators, and professional and regulatory bodies. The process followed a snowball approach.

WHO African Region | 45WHO African Region | 45

Consultations with expertsA selected group meeting of experts in the various subject areas was convened (Nairobi, 18 to 22 September 2017) to review the draft competencies based on Delphi Round 1 survey responses and to decide on the way forward. The group of experts reviewed the competencies for all the groups and made revisions by consensus. The resulting draft was now ready for Delphi Round 2 for consensus building as recommended.

E-meetings and a series of teleconferences of the Standing Advisory Group (SAG) and experts in the subject area agreed with the results of Delphi Round 2, and proposed a second face-to-face meeting of an enlarged group of experts (Nairobi, 27 February to 1 March 2018). This expert group which constituted most of the experts from the first and additional ones from the Ministries of Health undertook a detailed and reflective structured analysis and review of the whole process and validated both the core competencies and the whole process as one document.

The editorial team and final documentationThe consultant whose role was to gather all the material from the processes and document both the process and the main product, drafted the final draft document with additional support from some selected experts’ format of this process. The material was further enriched by the recently-developed WHO nursing and midwifery educator core competencies (28). The validated document was also technically proof read for accuracy after the validation by experts before the official editing as part of the normal WHO process for publication.

Figure 5: Process for developing, documenting and validating core competencies for the eye health workforce

Delineate the occupational groups of specialist eye health providers:ophthalmologists, optometrists, allied ophthalmic personnel

WHO occupational classification based on on ISCO-08

Develop competencies for each of the workforce groups

Joint process by AFRO and IAPB

Reviews and revise the competencies

Small expert group

Obtain consensus on the competencies

DELPHI process - wide group of stakeholders

Review and revise the competencies

Small expert group to electronically incorporate the Delphi results

Validate the competencies and reach FINAL CONSENSUS

27 February to 1 March 2018, Nairobi, Kenya


Annex II: PARTICIPANTS AT THE REGIONAL EXPERTS CONSULTATION WORKSHOP ON EYE HEALTH CORE COMPETENCIES (19–22 September 2017, Nairobi, Kenya)

Name Function Country

Prof Komi Matiklu Balo Professor of Ophthalmology, University of Lome Togo

Dr Luigi Bilotto Director of Education, Brien Holden Vision Institute Canada

Mrs Ellen Anyeley Clegg Former Principal, Ophthalmic Nursing School, Korle Bu Ghana

Dr Renee du Toit Technical Advisor, IAPB Africa South Africa

Prof. Richard Ganga-Limando

WHO Collab. Centre for Postgrad. N&M Distance Ed., Res. U of S. Afr. South Africa

Dr Adrian Hopkins Facilitator, Adrian Hopkins Consulting UK

Prof Dunera Ilako Consultant Ophthalmologist, University of Nairobi Kenya

Mr Godfrey Kaggwa SiB Project Coordinator, Brien Holden Vision Institute Uganda

Prof Jefitha Karimurio Chair, Department of Ophthalmology, University of Nairobi Kenya

Dr Abigail Kazembe Assoc. Professor & Deputy Dean, Kamuzu College of Nursing, Malawi Malawi

Dr Grace Chipalo Mutati Senior Medical Superintendent, University Teaching Eye Hospital Zambia

Prof Fikile Ntombi Mtshali Sch. of Nursing & Publ. H., University of Kwazulu-Natal (WHO Collab. Centre) South Africa

Mr Peter Mwangi Kirigwi Optometry Technologist Trainer, Kenay Medical Training College Kenya

Prof Kolawole Ogundimu Senior Global Technical Lead, Eye Health, Sightsavers Nigeria

Dr Mollent Okech Senior Technical Advisor for HRH, Management Sciences for Health Kenya

Dr Joseph Enyegue Oye Central Africa Co-Chair, IAPB-Africa, Country Director, Sightsavers Cameroon

Mr Senanu K Quacoe-Wossinu

Francophone & Lusophone West Africa, Co-Chair, IAPB-Africa Togo

Ms Zahra Rashid Optometrist, Private Practice Kenya

Prof Jefitha Karimurio Chair Department of Ophthalmology, University of Nairobi Kenya

Dr Abigail Kazembe Assoc. Prof-Deputy Dean, Kamuzu Coll. of Nursing, Malawi University Malawi

Prof Fikile Ntombi Mtshali Sch. of Nursing & Pub. Health, University of Kwazulu-Natal (WHO Collab. Centre) South Africa

SECRETARIAT

Dr Adam Ahmat Technical Officer, HRH & Planning, WHO Regional Office for Africa Congo

Mr Simon Day Regional Coordinator, IAPB-Africa South Africa

Dr Michael Gichangi NECC, Kenya, Ministry of Health Kenya

Dr Hillary Kipruto Adviser, HSS, WCO, Kenya Kenya

Mrs Anabay Mamo WCO, Kenya Kenya

Ms Jennifer Nyoni Technical Officer, HRH Management, WHO Regional Office for Africa Congo


AFRO-IAPB EXPERTS MEETING (Nairobi, 19–22 September 2017)

Meeting SummaryIn September of 2017, AFRO and IAPB held a consultation workshop in Nairobi, Kenya. The workshop was attended by eye health experts with the overall objective of reviewing draft core competencies for the three groups of specialist eye health professionals in sub-Saharan Africa: ophthalmologists, optometrists, and allied ophthalmic personnel before finalization and validation by eye health and related experts.

Development of competency frameworks for the different levels of the eye health workforce is a critical component of the IAPB-Africa strategy on human resources for health. The workshop was a major milestone in this regard. The ultimate purpose of the competencies was to improve the quality and relevance of the care provided by the professional eye health workforce. Such improvement would contribute to the attainment of Universal Health Care.

The event was organized jointly by AFRO and IAPB-Africa and funded entirely by IAPB-Africa, with support from the International Centre for Eye Health Vision 2020 Workshop Fund. Throughout the event, the proceedings were facilitated by Dr Adrian Hopkins. Also in attendance was Dr Michael Gichangi, the consultant hired by AFRO to drive this process. Invited experts were made up of representatives of each of the cadres and were drawn from the different linguistic groups and sub-regions of the continent. During the workshop, their role was to critically review a set of draft core competencies in terms of their content, terminology and layout. Time was then allowed for discussion until consensus was reached on each component.

There were rich and lively debates during the review and in plenary sessions which examined in detail the differences among the three cadres as well as the key content of the competencies and their domains. The outcome of the workshop was a revised set of core competencies which were approved by all participants. The next step was submission of the competencies to a Round 2 of the Delphi process. The outcome of Delphi Round 2 would be submitted for final review and approval during a second meeting of experts and country representatives scheduled for the first quarter of 2018.


Annex III: PARTICIPANTS AT THE VALIDATION CONSULTATION (Nairobi, Kenya, 27 February to 1 March 2018)NAME FUNCTION & ORGANIZATION COUNTRY

Dr James Amoo Addy Head of Eye Unit, National Coordinator, Prevention of Blindness Ghana

Dr Mouctar D Badiane Coordinator of the national eye health Promotion Program Senegal

Dr Luigi Bilotto Director of Education, Brien Holden Vision Institute Canada

Dr Grace Chipalo Mutati Sr Medical Superintendent, University Teaching Eye Hospital Zambia

Mrs Ellen Clegg Anyeley Past Principle, Ophthalmic Nursing School, Korle Bu Ghana

Dr Renee du Toit Technical Advisor, IAPB Africa South Africa

Prof André Omgbwa Eballe Deputy Coordinator, Prevention of Blindness Programme Cameroon

Prof RM Ganga-Limando WHO Collab. Centre for Postg. N&M Distance Ed., Res. Univ. of S. Africa South Africa

Dr Adrian Dennis Hopkins Facilitator, Adrian Hopkins Consulting UK

Prof Dunera Ilako Consultant Ophthalmologist, University of Nairobi Kenya

Dr Michael Gichangi Head of ophthalmic Services Unit- MOH Kenya

Mr Godfrey Kaggwa SiB Project Coordinator, Brien Holden Vision Institute Uganda

Prof Jefitha Karimurio Chair Department of Ophthalmology, University of Nairobi Kenya

Mrs Annette Kobusingye Program Manager, the Fred hollows Foundation, African Region Uganda

Dr Aaron T. Magava Chair, IAPB Africa Zimbabwe

Dr Silvio Paolo Mariotti Senior Medical Officer/WHO HQ Switzerland

Dr Simona Minchiotti Eye Health Consultant/WHO AFRO Italy

Prof Ntombi Fikile G Mtshali Sch. of Nursing & Pub. Health, Univ. Kwazulu-Natal (WHO Coll. Centre) South Africa

Mr Peter Mwangi Kirigwi Optometry Technologist Trainer, Kenay Medical Training College Kenya

Mrs Annette Mw Nkowane Independent consultant Zambia

Dr Mollent Okech Senior Technical Advisor for HRH, Management Sciences for Health Kenya

Dr Joseph Enyegue Oye Central Africa Co-chair IAPB Afr, Country Director Sightsavers Cameroon

Mr Senanu Quacoe Francophone & Lusophone West Africa Co-Chair IAPB Togo

Ms Zahra Rashid Optometrist, Consultant Low vision Kenya

Dr Bernadetha Robert Shilio National Eye Care Program Manager, Ministry of Health Tanzania

Mrs Kassa Tsehaynesh Tiruneh

Direct T.A (acting as National Eye Health Coordinator) FMoH, Ethiopia Ethiopia

Dr Linda Visser Acad. Head, Dep. of Ophth.,Vice-Pres. OSSA, Pres., College of Ophth., S. Afr South Africa

Dr Adam Ahmat Technical Officer HRH and Planning, WHO Regional Office for Africa Congo

Mr Simon Day Regional Coordinator, IAPB Africa South Africa

Dr Hillary Kipruto Adviser, HSS, WCO, Kenya Kenya

Mrs Anabay Mamo WCO, Kenya Kenya

Dr Conall Ó Deasmhúnaigh WCO, Kenya Kenya

Ms Jennifer Nyoni Technical Officer, HRH Management, WHO Regional Office for Africa Congo


REGIONAL EYE COMPETENCIES VALIDATION WORKSHOP

(Nairobi, Kenya, 27 February to 1 March 2018)Workshop summaryThe objective of the Nairobi workshop was to validate the core competencies required to inform training and the quality of care given by eye health personnel throughout the WHO African Region.

An opening statement from the WHO Country Representative, Dr Rudolf Eggers, was delivered by Dr Joyce Nato, focal point for Noncommunicable diseases at the WHO Country Office, Nairobi, Kenya. In those opening remarks, the audience was reminded of the challenges of eye health and the enormous human suffering that loss of sight causes to affected individuals and their families. Poor eye health also represented a public health and social and economic problem, especially for developing countries. Dr Nato said that approximately 180 million people worldwide were visually disabled. Of these, between 40 million and 45 million persons were blind and that around 60% of them resided in sub-Saharan Africa, China and India.

She said approximately 50% of the world’s blind suffered from cataract, and about 80% of global blindness was avoidable. Despite half a century of efforts, commencing with organized trachoma control activities, the global burden of blindness was continuing to growing largely because of population growth and ageing. WHO and its partners had launched a common agenda for global action called ‘Vision 2020 - the right to sight’ which provided a platform to address blindness. The validation workshop in Nairobi was therefore timely. A framework that helped professionals effectively address eye health problems in the African Region was important as the Region was the hardest-hit with cases of avoidable blindness.

Dr Michael Gichangi, the consultant recruited to draft the competencies, also highlighted the crisis in human resources for health in the Region, underscoring the fact that of the close to 10,000 optometrists in Africa, most were in Nigeria and South Africa. The rest of the countries in the Region had very few. In fact, 78% of the countries in the Region had less than 50% of the optometrists. Even though Africa bore the heaviest burden of eye health disorders, the existing 200,000 ophthalmologists globally were concentrated in countries of the West and other regions. Based on the IAPB Vision Atlas and the training institutions database, current gaps in the Region were evaluated to be about:

• 2,000 ophthalmologists• 3,600 optometrists• 6,000 allied eye health professionals.

Ms Jennifer Nyoni, representing AFRO, provided the regional context and outlined the crisis in human resources for health (HRH) in the Region. The comprehensive response to the HRH crisis in the Region was based on World Health Assembly resolutions WHA 59.25 and 66.33 on scaling up the health workforce as well as on the subsequent guidelines on transforming health professional education as supported by the Lancet Commission report on transforming education (Frenk et al. 2010). Those documents provided a sound foundation for a comprehensive production of a health workforce that was relevant to the content, of good quality, and in appropriate numbers to address the needs of the peoples of the Region.

Ms Nyoni further outlined the process for the development of the eye health competencies, stating that development of the initial draft had utilized key reference documents that included global and regional competencies, e.g., the WHO midwifery core competencies, CanMEDS, various curricula from educational institutions, national health policies, ISCO-08, scientific publications, and World


Health Assembly resolutions and reports. Experts at the workshop were invited to participate fully and to focus their attention on the successful validation of the process that had led to the current draft of competencies for eye health professionals.

For the duration of the workshop, the experts held intensive discussions on the ten competency domains: (i) curative care; (ii) surgical care; (iii) preventive and promotive care; (iv) palliative and rehabilitative care; (v) communication; (vi) leadership and management; (vii) health advocacy; (viii) community practice, collaboration and team work; (ix) scholarship, research, teaching, mentoring, and lifelong learning; (x) professionalism. The domains embodied common non-clinical and clinical competencies. Feedback from group discussions was progressively integrated into the draft document over the three days of the workshop. Every evening, resource persons (comprising WHO, IABP and the consultant) reviewed the agenda and suggested ways of improving subsequent agendas as necessary.

The way forwardAt the conclusion of the workshop, the agenda for immediate and long-term activities was discussed. Of special note was the interactive and very constructive character of the validation workshop. Many inputs were made by these senior-level participants both during group work and in plenary sessions. Since the lead facilitator was a professional in eye health, he played a key role in moderating the group to discuss and reach consensus on sometimes contentious aspects. WHO and IAPB reaffirmed their commitment to seeing through the process as set out above, with the support of the editorial team.


Annex IV: FUNCTION AND TARGET AUDIENCES FOR THE COMPETENCY FRAMEWORK

Function Target audience

Development, review and implementation of curricula for initial and continuing competency-based education, e.g., for determining learning outcomes and for assessment of knowledge, skills, and attitudes that are relevant to the context and are socially suitable for inter-professional education

Educational institutions

Use of learning outcomes to help understand the expectations of training and as resource material for self-paced or directed learning

Learners

Guides for professional development requirements, and for peer appraisals

Professional associations

Assessments for qualification, licensure, institutional accreditation, and regulation

Licensing and regulatory authorities; Examining boards

Promotion and facilitation of networking and harmonized training to provide greater equivalence and mobility amongst the eye health workforce in sub-Saharan Africa

Decision makers, policy makers and planners; educational institutions, ministries for education or health

Guidance for policies on workforce planning and management, e.g., skills mix and task shifting or sharing, based on shared or common competencies, and differentiated by competencies unique to the group. The latter can be used to categorize the work of groups and subgroups; they help to clearly define roles and responsibilities in the eye health team as well as their tasks in job descriptions; this in turn also facilitates supervisory and mentoring activity, enhances professional recognition, career progression, and remuneration for existing or proposed cadres

Policy makers and planners; ministries for education or health; labour groups and employers

Strengthening the delivery of integrated and person-centred health services and care; Example, a decision on the competencies a team needs can lead to the appropriate allocation of these to team members, thereby facilitating or encouraging collaborative practice, work across health and non-health sectors and resulting in the provision of more holistic and integrated care

Civil society

Guidance for polices on health system strengthening and support can be provided in the form of supervision and equipment to enable the health workforce implement the competencies; doing so could help meet the needs of patients along with the expectations of both the population and the health system

Policy makers; ministries for education or health


Annex V: THE DELPHI SURVEY

Delphi 1

Expert group 1

Delphi 2Expert

Group 2

Number of competencies

Number (%) reaching

consensus*


Number (%)

reaching consensus*


validated

Co

mp

eten

cies

Ophthalmologists 12 10 (92%) 12 12 (100%) 14

AOP (clinicians) 14 12 (86%) 17 16 (94%) 16Total AOP

25AOP (nurses) 9 9 (10%) 10 10 (100%) 11

Optometrists 22 19 (91%) 26 24 (92%) 26

Ophthalmic opticians

18 8 (44%)Group omitted - lack of consensus;

confusing terminology

Common non-technical competencies

17 17 (100%) 16 16 (100%) 18

Res

po

nse

rate

s

Number of surveys emailed

94 57

Number of responses

57 (61%) 39 (68%)

Percentage from Africa

91% 86%

% from Kenya 36% 46%

% from training institutions

63% 49%

Qua

lifica

tio

n/

cad

res

Ophthalmologists 62% 62%

AOP (clinicians) 12% 9%

AOP (nurses) 8% 6%

Optometrists 15% 14%


Western Sahara

Tunisia

Sudan

Somalia

Morocco

Libya

Egypt

Djibouti

Zimbabwe

South Sudan

Sierra Leone

Seychelles

Sao Tome and Principe

Rwanda

Niger

NamibiaMauritius

Mauritania

Mali

Madagascar

Lesotho

Guinea-Bissau

Guinea

Gambia

Gabon

Eritrea

Equatorial Guinea

Democratic Republic of Congo

Congo

Comoros

Chad

Central African Republic

Cabo Verde

Botswana

Benin

Angola

Algeria

Zambia

UR Tanzania

Uganda

Togo

South Africa

Senegal

Nigeria

MozambiqueMalawi

Liberia

Kenya

GhanaEthiopia

Eswatini

Côte d'Ivoire

Cameroon

Burundi

Burkina Faso

A summary of the respondents and responses on the core competencies during the two rounds of Delphi, discussions, consensus, and validation of the competencies at two expert meetings.

Delphi respondents’ local across Africa

Bukina Faso

Burundi

Cameroon

Cote d’Ivoire

Eswatini

Ethiopia

Ghana

Kenya

Liberia

Malawi

Mozambique

Nigeria

Senegal

South Africa

Togo

Uganda

United Republic of Tanzania

Zambia

Delphi respondent locations – Africa.csv


Annex VI (a): OPHTHALMIC DIAGNOSTIC TESTS AND SURGICAL PROCEDURES

This Annex VI (a) gives general guidance for the purpose of harmonizing different clinical procedures within the scope of eye health service delivery. It also delineates the procedural scope of each provider. This is a core (minimum) list of basic procedures in Ophthalmology and should be viewed within the specific individual context of the country or institution. From this Annex, it is recommended that:

• All newly qualified ophthalmologists should be proficient in performing and interpreting diagnostic tests;

• All allied ophthalmic personnel should be proficient in performing and interpreting the above, except categories marked x** where additional competencies are required;

• Optometrists should be able to acquire competencies to perform all the diagnostic tests; they will need the relevant competencies to be able to interpret the findings of the tests;

• Optometrists with required competencies could perform limited surgical procedures; epilation, incision and drainage of chalazion and lid abscesses,*** removal of conjunctival and corneal foreign bodies, and participate in pre- and post-operative surgical care;

• ++ Supervision is provided directly when the ophthalmologist is actually present, observes, works with and directs the clinician or indirectly when the ophthalmologist works in the same facility or organization as the clinician but does not constantly observe his or her activities. The ophthalmologist must be available for reasonable access, i.e., must be available at all times.

Key to Annex VI (a)

Sign Meaning

• Within the primary competency of the cadre

x Not within the primary competency of the cadre

• **Although within the primary competency of the cadre, a practitioner will seek persons with further competencies in refractory procedures

x** Although the procedure may not be within the primary competency of the cadre, the person who has acquired relevant competencies is not limited and should seek to work within the country regulatory context.

x*** As above (x**) but will need close direction++ by an ophthalmologist, directly or indirectly.

PROCEDURE OphthalmologistsAOPs

(clinicians)AOPs

(nurses)Optometrists

OPHTHALMIC DIAGNOSTIC TEST

Tonometry ü ü ü ü

Pachymetry ü ü ü ü

Gonioscopy ü x** x** ü

Retinal photographs ü ü ü ü

Fluorescein angiography ü x** x** x**

Visual field analysis ü ü ü ü

Ocular-computerized tomography (OCT) ü ü ü ü

Corneal topography ü ü ü ü

Ultra-sound-eye* ü x** x** x

Biometry ü ü ü ü

Retinoscopy ü ü ü ü

Endothelial cell count ü ü ü ü

Direct & indirect fundus assessment ü ü ü ü

Syringing and irrigation ü ü ü ü

üü



(clinicians)AOPs


SURGICAL PROCEDURE

ORBIT, SOCKET, LACRYMAL AND LID

Infiltrate local anesthesia ü ü x*** x**

Dermoid excision simple ü ü x x

Dermoid excision complex ü x x x

Anterior orbitotomy ü x x x

Lateral orbitotomy ü x x x

Orbital wall repair x** x x x

Orbital wall decompression x** x x x

Mucoceale incision and drainage(I&D) ü x x x

Exenteration ü x x x

Evisceration ü ü x x

Evisceration and orbit implant ü x** x x

Enucleation ü x*** x x

Enucleation and orbital implant ü x x x

Socket fornix reconstruction x** x x x

Punctoplasty ü x x x

Punctal occlusion (temporary) ü ü x*** ü

Probing irrigation and syringing ü ü x x

Dacryo-cysto-rhinostomy(DCR) ü** x x x

Trachomatous entropion repair ü ü x ** x **

Other Non-trachomatous entropion repair ü** x x x

Epiblephron repair x** x x x

Ptosis repair ü x x x

Blow out lift x** x x x

Lid – canaliculi laceration repair ü x x x

Lid - Tumour excision (reconstruction) ü x x x

Tarsorhaphy ü ü x** x

Upper lid blepharoplasty- ü x x x

Lower lid blepharoplasty- ü x x x

Lid abscess (incision and drainage) ü ü x** x**

Chalazion (incision and drainage) ü ü x** x**

Epilation-A (simple non trachomatous) ü ü ü ü

Lashes electrolysis-A ü ü x** x

ANTERIOR SEGMENT AND CORNEA

Small incision cataract surgery + IOL ü x** x x

Small incision cataract surgery+IOL+TET ü x x x

Phaco-emulsification +IOL ü x** x x

Phaco-emulsification+IOL + Trabeculectomy ü x x x



(clinicians)AOPs


Cataract surgery+IOL+Anterior vitrectomy ü x x x

Perforating eye injuries ü x** x x

Conjunctival Lesion excision ü ü x x

Conjunctival lesion excision+ a graft ü x x x

Corneal transplant (penetrating keratoplasty) x** x x x

Corneal transplant (Lamella keratoplasty) x** x x x

Triple-procedure: Corneal transplant, Cataract surgery + IOL implantation x** x x x

Removal of corneal sutures theatre slit lamp ü ü x x

Removal of corneal foreign body ü ü ü ü

Posterior capsulotomy ü x x x

Anterior chamber(A/C) Tap/injection ü x x x

Pre-/post- refractive surgery assessments ü x x ü

Sub-conjunctiva/tenons injections ü ü x** x

Refractive surgeries x** x x x

Surface ablation x** x x x

Phakic intraocular lens ü x x x

Photo keratectomy x** x x x

Removal of corneal scar x** x x x

GLAUCOMA

Trabeculectomy ü x x x

Trabeculotomy ü x x x

Goniotomy ü x x x

Combined phaco/trabeculectomy x** x x x

Combined MICs and trabeculectomy x** x x x

Glaucoma-drainage implants (GDI) x** x x x

Combined GDI and phaco x** x x x

Surgical iridectomy ü x** x x

EUA for congenital glaucoma ü x x x

Retrobulbur alcohol/largactail ü ü x x

Laser: Trabeculoplasty, iridotomy, suturelysis ü x x x

Bleb revision ü ü x x

CycloCryotherapy-A/B ü ü x x

PAEDEATRIC OPHTHALMOLOGY

Anterior chamber reformation x** x x x

Goniotomy x** x x x

Intra-ocular lens (IOL) exchange x** x x x

Lensectomy and IOL implant x** x x x



(clinicians)AOPs


PAEDEATRIC OPHTHALMOLOGY continued

Anterior chamber membrane removal x** x x x

Pupiloplasty x** x x x

Anterior chamber wash out ü x x x

Corneal repair ü x x x

Removal of corneal FB ü ü x ü

Examination under-anaesthesia (EUA) for Retinoscopy, Rb, FB ü ü x ü

Pars plana capsulotomy ü x x x

Iridectomy/Iridotomy ü x** x x

Optical iridectomy ü x** x x

STRABISMUS MANAGEMENT

Surgical strabismus correction x** x x x

POSTERIOR SEGMENT AND RETINA

Central laser ü x x x

Pan retinal photo coagulation (on slit lamp) ü x x x

Pan retinal photo coagulation (on indirect head lamp) ü x x x

Laser retinopexy ü x x x

CycloCryotherapy ü x** x x

Cyclophoto coagulation/therapy ü x x x

Intra-vitreal injections ü x** x x

Silicon oil removal x** x x x

Cataract surgery with silicon oil removal x** x x x

Posterior vitrectomy with dropped IOL or Vitreous foreign body removal x** x x x

Posterior vitrectomy and gas x** x x x

Posterior vitrectomy + oil x** x x x

Posterior vitrectomy and delamination and gas and oil x** x x x

Combined procedures (Posterior vitrectomy, cataract surgery and IOL implants)

x** x x x

Combined procedures (posterior vitrectomy buckle or band+ cataract surgery and IOL implant)

x** x x x

Posterior vitrectomy and macula hole surgery x** x x x

Scleral buckle and explants removal ü x x x


Annex VI (b): OPTOMETRIST’S USE OF PHARMACHOLOGICAL PRODUCTS AND TREATMENTCategory of ophthalmic medicine Indication

Anti-infective agents Bacterial conjunctivitis and blepharitis

Ocular (non-steroidal) allergy medicine Ocular allergies and inflammation

Dry eye therapies and products Ocular surface disease or dry eye

Dilation & cycloplegic agents Ocular examination

Topical anesthetics Ocular examination and FB removal

Topical dyes Ocular examination

Contact lens solutions Contact lens hygiene, lubrication and maintenance

Atropine Myopia management or control

Note: NO STEROIDS


IAPB HReHtask development teams

Renee du Toit (w AOP Chair + HReH Chair)

Ellen Clegg

Ciku Mathenge

Halli Manalakos

Lynn Anderson

Joseph Oye

Godfrey Kaggwa

Janvier Kilangalanga

Mary Wepo

Ken Kagame (Ophthalmology Chair)

Kunle Hassan

Patrice Komi Balo

Margarida Chagunda

Dunera Ilako

Yeshigeta Gelaw

Seth Lartey

Irmela Erdmann

Ahmad Gomaa

Henry Nkumbe

Hannah Faal (CHW Chair)

Uche Amazigo

Henrietta Monye

Amir Bedri

Ima Chima

E Appiah-Denkyra

Bo Wiafe (PEC Chair)

Maria Hagan

Dorcas Chelanga

Hannah Faal

Kesi Naidoo (Optometry Chair)

Imran Khan

Senanu Quacoe

Nigel Wilson

Anguyo Dralega

Vanessa Moodley

Angela Affran

Annex VII: LIST OF PERSONS INVOLVED IN THE PROCESS

Delphi Rounds 1 and 2 participants

No Name Country

1 AdedayoAdio Nigeria

2 Agnes Mualuko Kenya

3 AlemayahuWoldeyesTefera Ethiopia

4 Anne AmpaireMusika Uganda

5 BoubacarSarr Senegal

6 Catherine K. Gargu Liberia

7 Claire Studley Scott UK

8 Clare Gilbert UK

9 Claudio Owino Kenya

10 Dorothy Mutie Kenya

11 Elijah Mutoloki Munachonga Zambia

12 Ellen Anyeley Clegg Ghana

13 Ernest Ollando Kenya

14 George S. Odhiambo Ohito Kenya

15 Grace Chipalo Mutati Zambia

16 Imran Khan UK

17 Irmela Erdmann Togo

18 Jefitha Karimurio Kenya

19 Jonathan Buturu Kenya

20 Judith Mwende Tanzania

21 Kahaki Kimani Kenya

22 Karl Golnik USA

23 Kesi Naido South Africa

24 Margarida Chagunda Mozambique

25 Milliam Kamau Kenya

26 Millicent Muthoni Kenya

27 Nicholas Olobio Nigeria

28 Nick Astbury UK

29 Nyawira Mwangi Kenya

30 Okenwa-Vincent Emmanuel Kenya

31 Rebecca Oenga Kenya

32 Sheila Marco Kenya

33 Stephen Gichuhi Kenya

34 William Makupa Tanzania

35 Zahra Rashid Kenya


Participants in Delphi Round 1 only

No Name Country

1 Dabilougou Adama Fulbert Burkina Faso

2 Levi Kandeke Burundi

3 Bella Assumpta Lucienne (2 rounds) Cameroon

4 Kouakoua Marie Madeleine Ivory Coast

5 Dennis Osiago (2 rounds) Kenya

6 Ernest B. Wanyama Kenya

7 Lucy Manyara Kenya

8 Monicah Bitok (2 rounds) Kenya

9 Petros Kanyange Malawi

10 Mariamo S Abdala Mozambique

11 Abubakar Jibril Rifun Nigeria

12 C Cook South Africa

13 France Nxumalo South Africa

14 Kgao Edward Legodi South Africa

15 Sharon Maseko Swaziland

16 Peter M. Kirigwi Kenya

17 Milka Mafwiri Tanzania

18 Quacoe-Wossinu Senanu (2 rounds) Togo

19 Babalanda Jean Uganda

20 Kaggwa Godfrey Uganda

21 Simon Arunga Uganda

22 Jessie Mbachi Innocencia Nyalazi Zambia

Other technical support and back-up staff (who worked very hard or wereconstantly consulted behind-the-scene by the Consultant, Dr Michael Gichangi)

Prof Emilee Epée Ophthalmologist (Proofreader) Cameroon

Dr Augustine Mwangi Educational Consultant, Lecturer, University of Nairobi Kenya

John Maina Murage, BSc IT and Data Manager Kenya

Dr Anthony Gichangi Statistician, JEPAIGO, Nairobi Kenya

Mrs Catherine Mwaura Ophthalmic Nurse-Trainer, Kenya Medical Training College Kenya

Dr Eduardo Mayorga Ophthalmologist, ICO Educator Argentina

Dr Joyce W Kabiru Ophthalmologist & Oculoplastic Surgeon Kenya

Prof Dan Kiage Ophthalmologist & Glaucoma Specialist Kenya

Dr Stephen Gichuhi Ophthalmologist & Epidemiologist, Senior Lecturer, University of Nairobi Kenya

WHO-IAPBSUBJECT EXPERTS PANEL

Dr Grace Misumbi Chipalo-Mutati

Prof Komi Balo

Dr Joseph Oye

Prof Dunera Ilako

Prof Abigail Kazembe

Mrs Ellen Clegg

Mr Godfrey Kaggwa

Dr Renee Du Toit

Dr Kola Ogundipe

Prof JefithaKarimurio

Prof Fikile Ntombi Mtshali

Dr Luigi Bilotto

Mr Senanu Quacoe

Mr Peter Mwangi Kirigwi

Ms Zahra Rashid

Prof Richard Nganga Limando

Dr Mollent Okech

Dr Adrian Hopkins

Dr Michael Gichangi

Mr Adam Ahmat

Dr Simona Minchiotti

Ms Jennifer Nyoni

Mr Simon Day


Members of the Standing Advisory Group that steered the core competencies process

Dr Adam Ahmat WHO African Region, HSS Cluster

Dr Simona Minchiotti WHO African Region, NCD Cluster

Mrs Mwansa Nkowane HWF Department, WHO HQ

Ms Jennifer Nyoni WHO African Region, HSS Cluster

Dr Michael Gichangi Main Consultant

Mr Simon Day IAPB

Dr Renee du Toit IAPB Expert

Mr Ronnie Graham IAPB

Mr Luigi Bilotto Director of Education, BHVI


Core Competencies

for the Eye Health

Workforce in the WHO

African Region

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